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R Stubbs

Publications and source records attributed to R Stubbs.

5 recordsLinked to original sources
PubMed2006

Evaluation of the role of CT in the assessment of response to selective internal radiation therapy in patients with colorectal liver metastases.

Selective internal radiation therapy (SIRT) is a relatively new method for treating non-resectable liver tumours. There is reason to believe that conventional assessments of response by CT scan may underestimate the efficacy of this treatment. A study was undertaken in 54 patients to evaluate CT changes after SIRT for advanced colorectal cancer and to compare these with tumour marker (carcinoembryonic antigen (CEA)) changes to determine how best to assess whether a response has occurred. Computed tomography scans were carried out before treatment and at 3-monthly intervals thereafter. Serial CEA measurements were undertaken at 4-weekly intervals. Index lesions were identified and their size was assessed on serial scans by three independent, blinded investigators. Per cent changes in CEA levels after SIRT were calculated for all patients. Disappearance of all index lesions was noted in five patients (9.3%). A decrease in the size was seen in a further 41 patients (76%), no change was seen in five (9.3%), and an increase in size was noted in three (5.4%). The time taken for the maximum decrease in size to occur ranged from 3 to 21 months (median 12 months). Carcinoembryonic antigen changes were more dramatic, with a reduction of more than 75% within 2 months in 35 of 50 patients (70%) and a rise in only 3 of 50 patients (6%). Early assessment of response by CT scan may be misleading because of the time taken for size reduction to occur. Response to SIRT is more accurately judged in the early stages by tumour marker data.

Adult↗
PubMed2000

Risk assessment in upper gastrointestinal haemorrhage: implications for resource utilisation.

AIMS: Acute upper gastrointestinal (GI) bleeding is a common and serious problem with an associated mortality of some 10%. It is desirable, both for optimising outcomes and for the efficient use of resources, that some form of risk assessment be made early and management be stratified accordingly. A risk scoring system was recently proposed and validated by Rockall and colleagues from the UK. We wished to assess its validity in a New Zealand setting. METHODS: 565 consecutive patients treated for acute upper gastrointestinal bleeding at Wellington Hospital between 1988 and 1991 were the subject of a major prospective study. All patients were retrospectively assigned a score of 0-7 based on presentation criteria as suggested by Rockall and colleagues. The score is a composite one having regard to age, haemodynamic variables on presentation and associated serious co-morbidity. Correlation was sought between the score and the in hospital mortality risk. RESULTS: The overall 30-day mortality was 11%. Of the 60.5% of patients with a total score of less than 4 ('low risk'), the group mortality was 3.2%. Of the 39.5% of patients with a total score of 4-7 ('high risk'), the group mortality was 22.4%. CONCLUSIONS: The scoring system appears as valid in a New Zealand patient population as in the UK. We suggest that this scoring system be adopted in hospitals for patients with acute upper GI bleeding to efficiently direct the use of 'intensive care' type facilities to those most at risk, and thereby optimise management.

Aged↗
PubMed1999

Hepatic resection for metastases in colorectal carcinoma.

AIMS: To outline the role of liver resection in the treatment of colorectal liver metastases, with particular reference to hospital morbidity, mortality and subsequent survival. METHODS: Seventy major liver resections were performed in Wellington by the senior author (RSS) between 1987 and 1997 for colorectal metastases. Fifty-three entailed resection alone with intent to cure, nine were associated with additional cryotherapy and in eight hepatic arterial chemotherapy was subsequently given. Resection was the initial form of liver treatment in all 70 patients. Patients were aged between 29 and 76 years with a median of 60.0 years. All patients were judged pre-operatively to have tumour confined to a resectable portion of the liver. Data were collected prospectively and held in a computerised database. Follow-up was available on all patients. RESULTS: Median operating theatre time was five hours and median blood loss was 1500 mL (60 mL-25 L). Eighty percent of resections entailed four or more liver segments. Postoperative morbidity occurred in 26 (37.1%) and 30-day mortality was 5.7%. Median hospital stay was 11 days (2-67). In the 53 patients who underwent resection alone, the three and five-year actuarial survival rates, including the 30-day mortality, were 62.0% and 27.2%, respectively. Dukes stage of the primary was the only significant prognostic factor found in this subgroup of patients (p<0.05). CONCLUSIONS: Resection of colorectal liver metastases can achieve extension of life and long-term survival in selected patients. However, it remains a major undertaking and is probably best performed in units with appropriate expertise and experience.

Adult↗
PubMed1989

Psittacosis pneumonia.

A 57-year-old man with symptoms and signs consistent with atypical pneumonia had epidemiologic and later serologic evidence of psittacosis pneumonia. Therapy with tetracycline resulted in rapid resolution.

Ciprofloxacin↗