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Biomedical subjects

C Wastell

Publications and source records attributed to C Wastell.

At least 55 records · Page 3Linked to original sources
PubMed1988

Perforated duodenal ulcer and cigarette smoking.

Whilst the association between smoking and peptic ulceration has been reported previously, the relationship between smoking and the complications of ulcers, such as perforation, bleeding or acute painful exacerbation, has not been examined. In a retrospective study comparing 275 emergency admissions for peptic ulcer with 275 controls, cigarette smoking was significantly more common only in those with a perforated duodenal ulcer. Of 128 patients with perforated duodenal ulcers, 110 (86%) were cigarette smokers compared with 65 (51%) of the 128 matched controls (X2, P less than 0.01). Cigarette smoking in patients with bleeding or acutely exacerbated ulcers was not significantly more common than in controls. These findings strongly suggest a particular association between smoking and perforated duodenal ulcer.

Duodenal Ulcer↗
PubMed1988

Clinical acute cholecystitis and the Curtis-Fitz-Hugh syndrome.

When patients are admitted with clinically diagnosed acute cholecystitis, no cause will be found for their pain in 9-13% (4.5). Our retrospective study shows that women between 15-35 years are most likely to be in this group. Our prospective study of all patients in the 15-35 year age group admitted with clinical 'acute cholecystitis', showed that in 6 out of 7 patients with 'undiagnosed' pain, the Curtis-Fitz-Hugh syndrome was the cause. We suggest that screening for the Curtis-Fitz-Hugh syndrome is performed in all patients with right upper quadrant pain who have a normal ultrasound scan.

Acute Disease↗
PubMed1987

The right approach to carcinoma of the cardia and lower oesophagus.

Successful surgical palliation for carcinoma of the cardia and lower oesophagus is often compromised by anastomotic failure or local recurrence. These complications follow technical difficulty in achieving adequate resection and a safe anastomosis through inappropriate surgical exposure, often via the left chest. A technique of oesophagogastrectomy is described employing a simultaneous right abdominothoracic approach without division of either costal margin or diaphragm. Synchronous laparotomy and thoractomy facilitates both resection and anastomosis, and obviates the necessity to turn the patient over and redrape halfway through the operation. Closure of the distal stomach and the gastro-oesophageal anastomosis are performed using staplers. No anastomotic leaks were detected in the 15 patients described.

Aged↗
PubMed1986

Randomized trial of oral adjuvant razoxane (ICRF 159) in resectable colorectal cancer: five-year follow-up.

Razoxane is one of the few agents which has shown activity in the treatment of advanced colorectal cancer. The drug has therefore been evaluated in a prospective randomized controlled trial as an adjuvant to surgery for resectable colorectal cancer. The results to median follow-up of 5 years are reported here. Accrual has ceased and a total of 272 patients entered the trial (133 control, 139 treatment). Treated patients received razoxane postoperatively on a continuous, long-term basis while control patients received identical clinical care but no adjuvant chemotherapy. Analysis of the results shows a significant prolongation of the time to recurrence for Dukes' C patients. All other groups including the overall analysis show no benefit although there is a consistent trend in favour of the treated patients except in Dukes' group 'D'. Razoxane is tolerated well by patients and causes minimal side-effects. However acute leukaemia occurred in three patients (2.45 per cent) after prolonged exposure to the drug and further evaluation should be in patients who are at high risk of developing recurrent cancer, in whom such a risk may be acceptable. It is concluded that razoxane is suitable for further evaluation in colorectal cancer and for incorporation into combination chemotherapy regimens.

Clinical Trials as Topic↗
PubMed1986

A controlled trial of cimetidine for the treatment of nonulcer dyspepsia.

Sixty patients with nonulcer dyspepsia took cimetidine 1 g daily or a placebo for 5 weeks in a double-blind trial. Thirty-four men and 26 women with normal double-contrast barium meals were included. Five percent had the endoscopic appearances of duodenitis. Symptoms improved during treatment in 62% of those taking cimetidine and in 54% of the placebo group (NS, p = 0.5). We suggest that significant duodenitis is uncommon in the absence of active or quiescent duodenal ulcer disease. From this study there is no evidence that cimetidine benefits those patients with normal double-contrast barium meals and no duodenitis endoscopically who nonetheless have symptoms similar to those of peptic ulcer disease.

Adult↗
PubMed1984

The surgical treatment of obesity.

Surgery for obesity has developed continuously since it was introduced in 1956. The early idea of small intestinal bypass has been refined to the point that the majority of surgeons agree that about 45 cm of small bowel should be left in continuity, 30 cm of jejunum and 15 cm of ileum. Providing care is taken to given dietary supplements plus a high protein, low fat, low oxalate and high calcium diet, together with a ready response to severe liver damage by treatment of bacterial infection in the bypassed loop, this operation or one of its variants appears to be reasonably safe. But it is nevertheless followed by significant and undesirable side effects. Wiring the jaw is effective in producing weight loss and has the advantage of simplicity and cheapness. Unfortunately when the suffer is released weight is gained in all cases. Gastric operations designed to reduce the size of the proximal stomach to a paltry 50 ml are of two types--gastric bypass in which the small and otherwise closed pouch is drained into the small bowel and gastroplasty in which a 9 mm stoma drains the pouch into the distal stomach. There is much to commend gastroplasty and reports so far do not indicate such a large number of late complications as with jejuno-ileal bypass. This surely is where the future of surgery in this condition lies.

Body Weight↗
PubMed1983

Superior mesenteric artery syndrome.

Superior mesenteric artery syndrome (SMAS) was diagnosed in a 16-year-old boy who presented with a short history of repeated vomiting associated with weight loss to the point of collapse. After resuscitation and investigation, he was treated surgically and subsequently recovered well. The diagnostic difficulties and possible pathogenesis of SMAS are discussed and the literature reviewed.

Adolescent↗
PubMed1982

Adjuvant oral razoxane (ICRF-159) in resectable colorectal cancer.

One hundred and seventy six patients (81 controls, 95 receiving treatment) have entered a prospective randomized trial of long-term oral adjuvant razoxane (ICRF-159) following removal of a colorectal cancer. The median follow-up is 34 months. The treated patients in Dukes' groups B and C have a significantly longer disease-free interval than the control patients (P = 0.01 'as randomized' and P = 0.004 'as treated'). The differences in survival for Dukes' groups B and C are not significant, although follow-up is short. In Dukes' groups B and C, however, 24 of 56 of the patients in the control group have died (43%), as against only 17 of 64 in the treatment group (27%). The treatment produces very few side-effects, is well tolerated by patients, and is taken orally.

Administration, Oral↗
PubMed1981

A controlled prospective trial of adjuvant razoxane in resectable colorectal cancer.

Following resection of their tumour, 162 patients with colorectal cancer entered a prospective randomized controlled clinical trial of adjuvant oral razoxane. Thirty-one patients were Duke's group A; 49 group B; 61 group C; and 17 group D; an additional four patients were randomized in error. The adjuvant group received the usual clinical care and 125 mg razoxane twice daily for 5 consecutive days (monday-friday) every week indefinitely. Control patients received the same clinical care as the adjuvant group, but no razoxane. At 3 years, 134 patients (84%) are evaluable. The recurrence rate in the first 6 months was 20% and 28% respectively in the Duke's B and C controls compared with 4% and 9% in the corresponding razoxane treated patients. Most recurrences occurred within the first 6 months from randomization. When all patients as randomized are included in the analysis of survival, irrespective of whether they were cured by surgery (Duke's A), had advanced cancer (Duke's D), or took no razoxane when randomized to take it, then as might be expected any differences there may be between the razoxane-treated and control patients with minimal residual disease (Duke's B and C) are so distorted that the p value of the difference in survival was 0.93. If however only patients with Duke's group B or C are taken (49 controls and 47 treated), log-rank analysis reveals a difference in the cancer mortality curves (p = 0.07). If patients who had been randomized to take razoxane, but who had not taken it at any time (and therefore received the same treatment as controls) are analysed with the controls, the difference between the two groups increases further, with p less than 0.05. The razoxane-treated patients experienced no significant toxicity apart from a readily reversible mild leukopenia in 52% while gastrointestinal symptoms necessitated stopping the drug in only four patients. These four all took the drug for less than 4 weeks. Because there was no toxicity to subtract from any benefit razoxane adjuvant treatment produced and the quality of life was not impaired, the therapeutic benefit of surgery wsa increased to the extent that razoxane increased survival of patients with Duke's B and C tumours.

Clinical Trials as Topic↗