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Biomedical subjects

M V Madden

Publications and source records attributed to M V Madden.

At least 37 records · Page 2Linked to original sources
PubMed1990

Bacteremia after injection of esophageal varices.

Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients. The clinical importance of this phenomenon is uncertain. This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia. Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned. In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia. After 4 h, all blood cultures were sterile. No infective complications were identified. Bacteremia appears to be an infrequent and transient event after elective sclerotherapy. Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis.

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

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↗
PubMed1987

Gastric cancer. Some aspects of epidemiology, risk factors, treatment and survival.

Gastric cancer mortality has fallen sharply in many Western populations, yet world-wide it probably remains the single commonest cancer. A diet rich in salted or smoked food and low in vitamin C contributes to its pathogenesis, while the environmental type of atrophic gastritis and intestinal metaplasia are consistently associated and may represent precursors of malignant change. Better food preservation may have a protective effect. Since patients with gastric cancer usually present with incurable disease and survive for only a few months, only those likely to live long enough to benefit from surgery should be operated upon. In the small proportion of patients who have curable disease, extended lymph node dissection increases morbidity and has not convincingly been shown to prolong survival. The palliation offered by surgery, and particularly that achieved by chemotherapy and radiation, deserves further study. Screening for gastric carcinoma seems unlikely to decrease mortality.

Female↗
PubMed1987

Surgical staging of gastric carcinoma: sources and consequences of error.

Macroscopic 'TNM' staging was performed during 78 consecutive operations for gastric carcinoma and compared with subsequent pathological staging. Surgical assessment was correct for tumour (T) in 60 per cent when depth of invasion was assessed, for nodes (N) in 61 per cent, for liver metastases (M) in 92 per cent but for all aspects in only 21 per cent. Curability (conservatively defined as T1-3, N0-1, M0) was correct in 8 of 18 patients thus assessed at surgery and incurability was pathologically correct in 58 of 60 patients. Despite inaccurate surgical staging, no patient was denied a resection although 10 patients had unduly radical procedures for their stage and 2 had inappropriately conservative procedures for their stage (but without evidence of residual disease). Staging errors did not jeopardize conventional surgical management substantially and use of intra-operative microscopic sampling of nodes would have improved surgical treatment only minimally.

Humans↗
PubMed1987

Case for conservative management of selected fibro-adenomas of the breast.

To assess the safety of a conservative approach to fibro-adenoma of the breast we prospectively studied 321 women with this clinical diagnosis, and performed aspiration cytology and excision biopsy. There was histological confirmation of fibro-adenoma in 217 (68 per cent), the remainder having various benign conditions and 4 (1.3 per cent) had carcinoma. Aspiration cytology had a sensitivity of 87 per cent and a specificity of 76 per cent for fibro-adenoma. Three cases of carcinoma were identified cytologically and the fourth was regarded as suspicious. To estimate the risk of missing carcinoma we compared the annual frequency of carcinoma with fibro-adenoma in young women and found a ratio of 1:470 between 15 and 19 years, 1:133 between 20 and 24 years and 1:9 in the 25-29 age group. To assess patients' views on non-operative treatment of benign breast masses we asked 124 women, 10 days postoperatively, whether they preferred a conservative approach for a cytologically benign lump: 26 (21 per cent) opted for conservative management in the future and 8 (7 per cent) would have preferred conservatism rather than their recent excision. A conservative approach is safe for clinically and cytologically benign breast lumps in women under 25 years, but very few will accept it.

Adenofibroma↗
PubMed1986

Gastric carcinoma--a current clinical profile.

During 1983, 128 patients with gastric carcinoma presented to Groote Schuur Hospital, 71% of them were from the coloured racial group. The commonest symptoms were dyspepsia or pain (88%), and the average delay in presentation was 3 months. Barium meal, endoscopy, biopsy, and cytology were not completely sensitive in making the diagnosis. Most patients had advanced disease: nearly one-third had disease so advanced that surgery was not considered and a further third had a palliative gastrectomy. Surgery was considered to be curative in 16 cases (12.5%). The overall 24-month survival rate was 19%, which contrasted with a survival of 88% when curative resection was possible.

Adult↗
PubMed1985

Anorexia nervosa and necrotizing colitis.

Anorexia nervosa is associated with a mortality approaching 5% in patients severely enough affected to warrant hospital care (Hsu, 1980). The main causes of death are inanition, electrolyte disturbances or suicide. We report here a case of necrotizing colitis associated with anorexia nervosa, an association which has not been described previously.

Adult↗
PubMed1983

Topical antiseptics in addition to peroperative antibiotics in preventing post-appendicectomy wound infections.

The effect of using topical povidone-iodine spray in addition to a single dose of intravenous metronidazole was studied in a clinical trial involving 200 patients undergoing appendicectomy. Despite the metronidazole, patients with perforated or gangrenous appendices still had an unacceptably high rate of wound infection. Overall, no benefit resulted from the addition of the povidone-iodine spray. Sub-dividing the patients according to the macroscopic state of the appendix, the degree of bacterial contamination of the operative wound or the depth of subcutaneous fat also failed to reveal any advantage gained by using the antiseptic.

Administration, Topical↗
PubMed1981

The management of anal carcinoma.

In a 20-year survey of anal carcinoma at Groote Schuur Hospital 55 cases were studied retrospectively. Patients of mixed race with anal margin carcinoma had a median age 29 years below that of Whites with anal margin carcinoma. Patients in these two groups with anal canal carcinoma had the same median age. Anal margin tumours were smaller than anal canal tumours at presentation and had a substantially better 5-year survival rate. The approach to treatment of these conditions is outlined.

Adult↗