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Biomedical subjects

T W Balfour

Publications and source records attributed to T W Balfour.

18 recordsLinked to original sources
PubMed1991

Primary B-cell immunoblastic lymphoma of pancreas.

Extranodal lymphoma may present as an abdominal mass without evidence of disease elsewhere. Predominant pancreatic involvement with lymphoma is rare. Presenting as a pancreatic mass, it may be difficult to differentiate if from carcinoma. Ultrasound-guided fine needle biopsy and immunocytochemistry are helpful in establishing a histological diagnosis. It is important to differentiate lymphoma from carcinoma, because lymphoma is treated differently and has a better prognosis.

Adult↗
PubMed1989

Randomised, controlled trial of faecal occult blood screening for colorectal cancer. Results for first 107,349 subjects.

To assess the effectiveness of screening by faecal occult blood tests, 107,349 people without symptoms of colorectal disease identified from general practitioner records have been randomly allocated to test and control groups. 53,464 test subjects were invited to carry out the screening test; 27,651 (53%) of the 52,258 who received the tests did so. Further investigation of the 618 (2.3%) with positive tests showed 63 cancers (52% stage A) and 367 adenomas (266 subjects). Rescreening of subjects with negative results every 2 years (9510 first rescreen, 3639 second) has shown a significant fall in the rate of positive results (1.7% of 7344; 0.3% of 2906). Cancers have also been diagnosed in 20 subjects presenting in the interval between a negative test and rescreening, and in 83 non-responders. The incidence of cancer in the control group (123 subjects; 10.6% stage A) was 0.72 per 1000 person-years. Cancers detected by screening were at a less advanced pathological stage, but it is too early to show any effect of screening on mortality from colorectal cancer.

Adenocarcinoma↗
PubMed1988

Ureterosigmoidostomy complicated by polyp formation. Report of two cases.

Neoplasia associated with ureterosigmoidostomy is uncommon but important. Two patients, one of whom developed symptoms five years after the ureterosigmoidostomy had been taken down, are reported. The authors support the theory that these tumors may arise from the ureter. When ureterosigmoidostomies are dismantled, the site of implantation should be resected and the patients kept under long-term endoscopic review.

Adult↗
PubMed1988

Cefotaxime plus metronidazole appears more effective than piperacillin in the prevention of postappendicectomy wound sepsis. Preliminary results of a comparative trial.

Metronidazole suppositories have previously been shown to be superior to povidone iodine intraoperative wound spray in reducing postappendicectomy wound sepsis. In subsequent studies metronidazole suppositories and cefotaxime injections reduced the sepsis rate to 9.3%, while the same combination produced a wound sepsis rate of 7.6% compared with 17.2% for cefotaxime alone. In an ongoing study, metronidazole and cefotaxime are now being compared with piperacillin in a single-blind trial. Adult patients undergoing emergency appendicectomy in Nottingham have been included in this study, which has ethical committee approval. When the decision to perform emergency appendicectomy was made, the patient was randomly allocated a numbered pack. This contained either 3 x 1g injections of cefotaxime and 6 x 1g metronidazole suppositories or 3 x 2g injections of piperacillin and 6 placebos. 40 minutes before operation the patient received the first suppository and the remainder every 8 hours. The patient received the first injection of antibiotic by intravenous or intramuscular injection and the remaining doses 8 and 16 hours later. A wound was regarded as infected if pus discharged either spontaneously or on incision. 175 patients have been studied to date. The treatment groups were well matched for age and sex. Seven of the 77 patients in the cefotaxime/metronidazole group (9.1%) compared with 12 of the 76 in the piperacillin group (15.8%) have developed wound infections. This study confirms that the combination of cefotaxime and metronidazole seems to be more effective than piperacillin alone in the reduction of postappendicectomy wound sepsis. Currently cefotaxime plus metronidazole is the therapy of choice.

Administration, Rectal↗
PubMed1986

Fecal occult blood screening for colorectal cancer in the general population. Results of a controlled trial.

A total of 26,975 asymptomatic individuals were identified from family doctors' age/sex registers and randomly allocated to test or control group. The first test group (10,253) were offered 3-day fecal occult blood (FOB) testing; 3,613 (37%) completed the tests and 77 (2.1%) were found to be positive. In this group, 13 cancers were detected (3.5/1000 persons screened), of which 9 (70%) were Stage A. Of these subjects, 3349 have been rescreened at 2 years; 2799 (85%) completed the tests and 80 (2.8%) were found to be positive. Four cancers have been detected (three Stage A). In the whole test group followed for 2 years (10,462), 34 cancers have presented (17 screening detected, 3 interval cases in test responders, 14 symptomatic cancers in nonresponders), of which 14 (43%) were Stage A. In the control group (10,272 individuals), 17 patients have presented with symptomatic colorectal cancer during the 2-year follow-up, with rates of 0.9/1000 and 0.8/1000 persons/year in the first and second years of follow-up, respectively. No Stage A tumors were present. In the second test group (3,225) offered both guaiac (Hemoccult; Smith Kline Diagnostics) and immunologic (Feca EIA; Nordic) FOB tests, 1304 (44%) completed the tests, of which 126 (9.7%) were positive. Five cancers were detected (four Stage A), of which only three were positive by Hemoccult testing. In this group of test responders, one cancer has presented symptomatically at 1 year follow-up. Thus, at 2-year follow-up of the responding individuals of both cohorts of the initial screen of the test group, 5 of 21 cancers (24%) were negative by Hemoccult testing. Fecal occult blood testing has doubled the detection of colorectal cancer in the test group compared with the number presenting with symptoms in 2 years in the control group, and increased the proportion of early stage cancers (chi 2 = 8.0, P = less than 0.001).

Aged↗
PubMed1985

A comparison of an immunological faecal occult blood test Fecatwin sensitive/FECA EIA with Haemoccult in population screening for colorectal cancer.

Two faecal occult blood tests, a simple chemical test Haemoccult and an immunological test, Fecatwin Sensitive/Feca EIA, were offered to 3,225 asymptomatic individuals as screening for colorectal cancer. One thousand three hundred and four (44%) completed and returned the tests and of these 126 (9.7%) were found to be positive - Haemoccult 40 (3%) and Feca EIA 106 (8.1%). Five cancers (4 Dukes' Stage A, 1 Dukes' Stage C) and 23 adenomas greater than 1 cm were detected - rates of 3.8 per 1000 persons screened and 17.7 per 1000 persons screened respectively. Of the five cancers identified 5 were Feca EIA positive and 3 were Haemoccult positive. Of the 23 adenomas greater than 1 cm diameter identified, J1 were Feca EIA positive and 20 were Haemoccult positive. Seventy-eight Feca EIA positive subjects were investigated and no neoplastic disease was identified. Whilst this sensitive immunological test increases the yield of carcinomas, the high false positive rate makes it unsuitable for population screening for colorectal cancer in its present form.

Adenoma↗
PubMed1985

Stones in the common bile duct: experience with medical dissolution therapy.

Thirty-one patients with radiolucent common bile duct stones received medical treatment. Nineteen had Rowachol, a terpene preparation, eight (42%) achieving complete stone disappearance within 3 to 48 months. Fifteen (including 3 of the above) took Rowachol with bile acid (chenodeoxycholic in 11, ursodeoxycholic in 4) for 3 to 60 months: 11 (73%) achieved complete dissolution within 18 months. Persistent symptoms and complications settled on conservative management: 8 (25%) patients required admission (2 biliary colic, 1 obstructive jaundice, 4 cholangitis, 1 pancreatitis). One patient died of a myocardial infarction during recovery from pancreatitis; the other continued treatment, 2 achieving complete dissolution/disappearance. Oral dissolution therapy with Rowachol and bile acids should be considered when endoscopic sphincterotomy or surgery is not feasible, but careful attention to potential complications is required while stones persist.

Adult↗
PubMed1976

Laparoscopy in liver disease.

Laparoscopy was technically successful in 73 of 75 patients in whom liver disease was suspected but not accurately diagnosed after medical investigation. In 46 patients (63%) the final histological diagnosis was either diffuse parenchymatous disease (cirrhosis/hepatitis) or metastatic malignant disease; 2 had a curable medical disease (tuberculous ascites); and 6 had a curable surgical disease (5 with gallstones and 1 with an ectopic adrenal tumour). There were no deaths and no serious complications. With increasingly accurate non-invasive techniques for localising lesions in the liver, laparoscopy, with directed biopsy, should help to provide correspondingly accurate histological confirmation.

Biopsy↗
PubMed1976

A comparison between suction and corrugated drainage after simple mastectomy: a report of a controlled trial.

A randomized prospective trial of closed suction wound drainage compared with corrugated wound drainage after simple mastectomy for early breast cancer (lesion confined to the breast and without skin ulceration) is reported. Fifty-one patients were admitted to the study and there was no difference between the two groups with respect to local complications such as ifection, skin necrosis and collection under flaps and wound healing. Dressings require to be performed significantly less frequently with suction as opposed to corrugated drainage and suction drains were removed significantly sooner than corrugated drains. It is concluded that closed suction wound drainage should be used after simple mastectomy.

Bandages↗
PubMed1975

Peritoneal nesothelioma.

Two patients with primary peritoneal mesothelioma are reported. They had abdominal symptoms, no symptoms referable to the respiratory system and normal chest X-rays. There was no clinical evidence of impaired respiratory function. One of the patients had a history of brief asbestos exposure over 20 years before diagnosis. The procedure for obtaining compensation is outlined and the protean uses of, and hence possible exposure to, asbestos are noted. In screening programmes consideration should be given to both pulmonary and abdominal symptoms. Laparoscopy may have a part to play in earlier diagnosis of peritoneal mesothelioma.

Aged↗