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Biomedical subjects

W M Chambers

Publications and source records attributed to W M Chambers.

6 recordsLinked to original sources
PubMed2005

Cancer surveillance in ulcerative colitis.

BACKGROUND: Patients with ulcerative colitis are at a higher risk of developing colorectal cancer than those without the disease. Surveillance programmes are used routinely to detect dysplasia and cancer in patients with ulcerative colitis. However, such programmes are poorly effective. This article discusses possible improvements suggested by recent research. METHODS: Papers relating to cancer associated with ulcerative colitis and surveillance programmes to detect such cancer were identified using Medline searches. Further papers were identified from the reference lists of identified papers. RESULTS: The probability of cancer for all patients with ulcerative colitis regardless of disease extent was 2 per cent at 10 years, 8 per cent at 20 years and 18 per cent at 30 years; the overall prevalence of colorectal cancer in any patient was 3.7 per cent. Indications for colonoscopic surveillance are extensive disease for 8-10 years, especially in those with active inflammation, a family history of colorectal cancer and primary sclerosing cholangitis. Problems affecting surveillance include the diagnosis of dysplasia, difficulty in differentiating 'sporadic' adenomas from a dysplasia-associated lesion or mass, and decision making based on surveillance findings. Molecular genetic and endoscopic advances to alleviate these problems are discussed. CONCLUSION: Rates of detection of dysplasia can be improved by chromoendoscopy. Molecular genetics has the potential to identify patients most at risk of cancer and can differentiate between different types of lesion.

Aneuploidy↗
PubMed2004

Tumour morphology as a predictor of outcome after local excision of rectal cancer.

BACKGROUND: The aim of this study was to determine whether the morphology of rectal cancer predicts outcome following treatment by local excision, and whether morphology should therefore be added to the criteria presently used for case selection. METHODS: The hospital notes and histological findings of 91 patients who had undergone a local surgical procedure for rectal cancer were reviewed retrospectively. Eight patient and tumour characteristics including morphology were analysed with respect to 5-year survival, local recurrence and cancer-specific death within 5 years. Morphology was divided into four types: polypoid, sessile, ulcerated and flat raised. RESULTS: Survival and local recurrence were significantly better for patients with exophytic (polypoid and sessile) carcinomas than for those with non-exophytic (ulcerated and flat raised) lesions. Multivariate logistic regression analysis showed that age, depth of invasion, lymphatic invasion and venous invasion were significant predictors of outcome. The exophytic group included significantly more stage T1 and fewer T2 and T3 cancers, and a significantly smaller proportion of tumours that showed venous and lymphatic invasion than the non-exophytic group. CONCLUSION: Morphology is a clinical guide to prognosis after local excision. Non-exophytic cancers are associated with high-risk histopathological features that render tumours of this type unsuitable for local excision.

Humans↗
PubMed2004

Postoperative leakage and abscess formation after colorectal surgery.

Anastomotic leaks following colorectal surgery may be divided into those which are clinically significant and those which are not. Leakage occurs in 3.4-6% of all colorectal cases. It is most commonly associated with rectal anastomoses, being clinically significant in 2.9-15.3% of cases. Mortality following a leak may be 6.0-39.3%. There is no evidence that preoperative bowel preparation reduces the rate and consequences of leaks. There is no evidence for the use of drains when an anastomosis has been made outside the pelvis, but pelvic drainage may be important after anterior resection. The use of covering stomas has not been shown to reduce leak rate but does mitigate the clinical effects of leaks. Prompt diagnosis and further laparotomy can reduce mortality following leakage. Intra-abdominal abscesses can in most cases be treated by radiologically guided drainage. Anastomotic leaks are the most common cause of anastomotic strictures and are also associated with increased rates of local recurrence of cancer.

Abscess↗
PubMed2001

Terbinafine-induced hepatic dysfunction.

A 41-year-old man developed severe hepatic dysfunction following a 3.5-week course of terbinafine (250 mg/day). He suffered marked pruritus, jaundice, malaise, anorexia and loin pain. Serum bilirubin rose to a peak value of 718 micromol/l with alkaline phosphatase at 569 U/l, alanine aminotransferase at 90 U/l, aspartate aminotransferase at 63 U/l and a prolonged prothrombin time of 21 s, unresponsive to vitamin K. Transjugular liver biopsy showed canalicular cholestasis consistent with a drug reaction. Symptoms resolved 11 months after drug cessation, with liver function tests returning to normal values after 15 months. This case represents the most severe cholestatic reaction reported to date, resulting in patient recovery without liver transplantation. A comprehensive literature review is provided.

Adult↗
PubMed1976

The eclectic and multiple therapy of a shoe fetishist.

This case history presents not only the therapists' point of view but also the client's. Four critical periods during therapy with a shoe fetishist were described by the two therapists and the client. The results of this procedure suggest that it is a facilitating method of gaining insight into the therapeutic process.

Attitude of Health Personnel↗