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Biomedical subjects

A B Price

Publications and source records attributed to A B Price.

At least 109 records · Page 6Linked to original sources
PubMed1981

Changing survival prospects in rectal and colonic cancer.

Cancer specific survival analysis in a series of 2204 patients managed by one of the authors for large-intestinal cancer shows a worsened outcome for patients treated operatively for rectal cancer from 1970 to 1979 in comparison with the two previous decades (p less than 0.05). Cancer specific survival after curative resection has also worsened (p less than 0.001). These changes are partly explained by an increase in Dukes' stage C tumours (p = 0.01). Paradoxically, the deterioration has been paralleled by earlier diagnosis (p less than 0.01). The worsened outcome cannot be accounted for by changes in sex or age distribution, tumour site, patient referral pattern or by an increase in sphincter-saving operations. The hypothesis advanced that a real change has occurred in the behaviour of rectal cancer in the Australian community requires further testing. There has been no significant change in survival prospects between the last two decades for colonic cancer patients treated operatively. A national cancer registry should be established to monitor changes in the epidemiology and survival prospects of large-intestinal cancer and other malignancies.

Adult↗
PubMed1981

Aetiology of acute diarrhoea in adults.

We have studied 73 adults with acute diarrhoea and identified a micro-organism or toxin likely to be the cause in 58%. In addition to routinely cultured bacteria, Campylobacter coli/jejuni and Clostridium difficile were important pathogens in the community. Patients who developed diarrhoea after antibiotic use had a distinctive clinical syndrome and comprised the third largest group of cases. Clinical, epidemiological, and histological features in an additional group with negative cultures and no antibiotic history suggest that an additional bacterial pathogen remains to be identified as a cause of acute diarrhoea in adults.

Acute Disease↗
PubMed1981

Ovarian involvement in adenocarcinoma of the colon and rectum.

Thirty-six of 998 female patients with carcinoma of the colon and rectum had ovarian involvement at the time of the initial operation. Resection of tumor of the colon and rectum was performed upon 882 patients. The ovarian tumors were removed in 30 of the 36 patients with ovarian involvement. Ovarian involvement was associated with a significantly worsened, p = 0.009, cancer specific five year survival rate; five year survival prospects for patients with, and without, ovarian involvement were 38 and 60 per cent, respectively. Ovarian involvement also significantly, p = 0.014, worsened the survival rate of the 25 patients treated by curative resection of the tumor of the colon and rectum and associated ovarian spread. The five year cancer specific survival rate for female patients without ovarian involvement was 72 per cent, whereas ovarian involvement reduced the survival rate to 50 per cent.

Adenocarcinoma↗
PubMed1981

Recurrence of carcinoma of the colon and rectum at the anastomotic suture line.

A total of 1,315 patients were treated by potentially curative resection for a single primary malignant tumor of the large intestine. Thirty-five or 2.7 per cent of the patients subsequently presented with a recurrent tumor at the site of the anastomosis. Fourteen of these patients were treated by further operation with curative intention, resulting in a median cancer-specific survival time of 41 months. The prognosis after resection of a recurrence of the tumor at the suture line was significantly better, p=0.001, than for patients in whom no further resection or palliative operation only was performed. None of the latter has survived for more than 30 months after confirmation of the recurrence, with a median survival time of 8.5 months.

Aged↗
PubMed1980

I. Carcinoma of the rectum and rectosigmoid: cancer specific long-term survival. A series of 1061 cases treated by one surgeon.

The long-term cancer specific survival based on individual follow-up and analysis of prospectively collected data from 1061 patients undergoing resection for carcinoma of the rectum is presented. All patients were operated on and managed by one surgeon. Survival data for 978 cases were analyzed according to the methods of Kaplan and Meier, and Gehan. Results have been presented as cancer specific survival times in months and as percentage survivor rates at five-year intervals. The median overall cancer specific survival time was 96 months. Five, ten, 15, and 20-year survival rates were 56, 49, 47, and 46%, respectively. After a potentially curative resection of the tumor, the corresponding percentages were 69, 60, 57, and 56%. Age and sex were not significant prognostic factors. A death rate from recurrent cancer of nil was seen after 15.4 years. At this point, the cancer specific survival rates were 77% for patients in Stage A, 59% in Stage B, 37% in Stage C, and 9% for patients with tumors invading adjacent organs (D1), while no patient with macroscopic metastases to distant organs (Stage D2) survived beyond four and a half years (median, 11 months).

Adenocarcinoma↗
PubMed1980

Results of operative management of Crohn's disease: A series of 50 patients managed by one surgeon.

A computer analysis has been made of clinical experience of Crohn's disease in Australian patients. Between 1950 and 1978, 50 patients were managed for Crohn's disease by one of the authors (E.S.R.H.). This group represented 3.1 per cent of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 years. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in seven patients, large intestine in 17 and both small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Forty-nine of the 50 patients required operative procedures and 36 underwent one or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after operation for combined small- and large-intestinal Crohn's disease. No patient with large-intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than second definitive operation (P = 0.007), the median recurrence-free intervals being 11 and 23 months, respectively.

Australia↗
PubMed1980

Epidemiology of experimental enterocecitis due to Clostridium difficile.

Hamsters can survive a course of clindamycin if they are held in a protected environment. Inoculation of Clostridium difficile regularly results in fatal enterocecitis in such animals but is without effect in untreated animals. These findings suggest that in the development of enterocecitis, clindamycin treatment and infection with C. difficile are separate events, and they imply that hamsters usually acquire C. difficile from environmental sources. Environments appear to differ in the risk of exposure to C. difficile, high-, medium-, and low-risk areas being recognizable. Once introduced, C. difficile may spread from animal to animal. Parallel with the incidence and epidemiology of human antibiotic-associated pseudomembranous colitis are discussed.

Animals↗
PubMed1980

Carcinoma of the colon. Cancer specific long-term survival. A series of 615 patients treated by one surgeon.

The cancer specific survival in 615 patients undergoing resection for carcinoma of the colon is presented. The patients were operated on and managed by one surgeon between 1950--1977. Computer analysis has been made of the prospectively collected data. Results are presented as median survival in months and as percentage survivors at 5, 10, 15 and 20 years. Curative resection gave a cancer specific survival at the seventy-fifth percentile of 66 months, corresponding to 76% survival at five years and 67% at 20 years. Age and sex were not significant prognostic factors. Dukes' Stages A, B and C had five-year survivals of 88%, 78% and 60% respectively, after curative resection. The median survival after palliative resection was 14 months. Site of the primary tumor within the colon was of significant prognostic importance only when the poor survival in tumors of the transverse colon was compared with the favorable survival in those of the splenic flexure, ascending, descending and sigmoid colon.

Adenocarcinoma↗
PubMed1979

Morphology of experimental antibiotic-associated enterocolitis in the hamster: a model for human pseudomembranous colitis and antibiotic-associated diarrhoea.

The morphology of antibiotic-associated enterocolitis in the hamster is described and compared with human antibiotic-associated pseudomembranous colitis. It is shown to be a caecal disease with proliferative mucosal changes and in this respect unlike the human counterpart. The bacteriology and toxicology, however, are identical. In addition, mucosal changes are described in animals on antibiotics but without established enterocolitis. As a result we suggest that there may be a spectrum of human disease ranging from mild antibiotic-associated diarrhoea to established pseudomembranous colitis. Therefore, despite the morphological variation, the hamster remains a good model for investigating the pathogenesis of pseudomembranous colitis and antibiotic-associated enteropathy in general.

Animals↗
PubMed1979

Acute diarrhoea: Campylobacter colitis and the role of rectal biopsy.

Campylobacter spp. were the organisms isolated most frequently from 29 consecutive patients admitted with acute diarrhoea to an infectious disease unit. Rectal biopsies taken from 21 of the patients were abnormal in all but four, and in the patients with campylobacter infection there was a characteristic proctocolitis in each case. The histopathology was similar to that described for salmonella and shigella infections but clearly different from typical ulcerative colitis and Crohn's disease. Therefore in patients with acute diarrhoea we suggest that selective culture for Campylobacter spp. should be made a routine and that rectal biopsy has an important diagnostic role, particularly in patients with negative cultures.

Acute Disease↗
PubMed1978

Clostridium difficile and the aetiology of pseudomembranous colitis.

Bacterial isolates from 5 patients with pseudomembranous colitis (P.M.C.) were screened for toxin production. Strains of Clostridium from 4 patients produced in vitro a toxin similar to that found in P.M.C. faecal suspension. These were identified as C. difficile. Use of the strains from 2 patients induced a fatal enterocolitis when inoculated orally into hamsters pretreated with vancomycin. The C. difficile that produced the toxin in vitro was then re-isolated from hamster caecal contents. These findings suggest that P.M.C. results from infection with C. difficile and that previous antibiotic therapy produces susceptibility to infection.

Adult↗
PubMed1978

Overlap in the spectrum of non-specific inflammatory bowel disease--'colitis indeterminate'.

It is stated that 10-20% of cases of non-specific inflammatory bowel disease cannot be classified. Thirty such cases, designated colitis indeterminate at the time of colectomy, were identified from the pathology files of St. Mark's Hospital. The Histopathological features of the surgical specimens and any available biopsy specimens were studied. In nearly all the cases urgent surgery had been required and the features of incipient or established fulminating disease were present. The pathology of these cases of Crohn's disease and ulcerative colitis overlapped, and differentiating features were scant or unreliable. Accepted criteria of Crohn's disease--namely, fissuring ulceration, transmural inflammation, and a maintained goblet-cell population--were found in cases subsequently proved to be ulcerative colitis. Disease activity greatly affected the evaluation of morphological features. Many of the difficulties were resolved when biopsy material obtained during a quiescent phase was examined. The specimens gave a dynamic perspective of the disease process, often more valuable than the static, non-specific picture of acute disease seen in the surgical specimens. Case of colitis indeterminate form a small distinctive group in the spectrum of inflammatory bowel disease which is characterised by a common pattern of pathology that presents a diagnostic dilemma.

Acute Disease↗
PubMed1977

Undescribed toxin in pseudomembranous colitis.

A girl aged 12 developed pseudomembranous colitis after a short course of oral penicillin. She had no history of adverse reaction to penicillin before or after the illness. No pathogenic bacteria, mycoplasmas, or viruses were found in her faeces, but they did contain a toxin. Toxin was also found in four of five other patients with pseudomembranous colitis but not in six specimens obtained from patients with diarrhoea caused by other disorders. Further studies may show that pseudomembranous colitis is caused by a bacterial toxin.

Bacterial Toxins↗
PubMed1977

Morphological and pharmacological studies of the parietal cells of the stomach in the dog during periods of maximal acid output and after the gastric secretory inhibitor UK-9040.

UK-9040, a derivative of the antihistamine triprolidine, is a potent gastric secretory inhibitor. Given orally to dogs it reduced gastric acid, pepsin and volume output in response to food, insulin, histamine, N-methyl histamine, and pentagastrin. Doses of 6-36 mg/kg administered orally four to five hours before the secretagogues produced a dose-dependant and up to 100% inhibition in the outputs of innervated gastric fistula and denervated Heidenhain pouch. Inhibition was still present 24 hours after administration of UK-9040 but was absent at 48 hours. Blood pressure and pulse rate were not affected. Studies with the electron microscope revealed that the normal ultrastructural responses to gastric secretory stimulation were arrested. UK-9040 showed no cumulative effect, tolerance did not occur, and after withdrawal of the drug the physiological and morphological gastric responses of the parietal cells rapidly returned to normal.

Animals↗
PubMed1977

Pseudomembranous colitis.

Three basic histopathological patterns which may be seen in rectal biopsies from patients with pseudomembranous colitis are described, based on a study of 29 cases. The spectrum of change is illustrated and the problems of differential diagnosis are discussed--from a non-diagnostic proctitis at one extreme to acute ischaemia at the other. In the differential diagnosis of the acute colitic, the importance of urgent rectal biopsy and a carefully taken drug history is stressed. The association of pseudomembranous colitis with pre-existing disease and antibiotic therapy is confirmed. It is suggested that these cause local mucosal damage and may trigger the first part of a local Shwartzman reaction. Capillary microthrombosis may then paly a part in producing the mucosal necrosis seen later in the disease.

Adolescent↗