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Biomedical subjects

D M Dent

Publications and source records attributed to D M Dent.

At least 73 records · Page 4Linked to original sources
PubMed1986

Gastric carcinoma--a current clinical profile.

During 1983, 128 patients with gastric carcinoma presented to Groote Schuur Hospital, 71% of them were from the coloured racial group. The commonest symptoms were dyspepsia or pain (88%), and the average delay in presentation was 3 months. Barium meal, endoscopy, biopsy, and cytology were not completely sensitive in making the diagnosis. Most patients had advanced disease: nearly one-third had disease so advanced that surgery was not considered and a further third had a palliative gastrectomy. Surgery was considered to be curative in 16 cases (12.5%). The overall 24-month survival rate was 19%, which contrasted with a survival of 88% when curative resection was possible.

Adult↗
PubMed1986

Choledochopancreatoduodenal fistula caused by duodenal ulceration. A case report.

A penetrating duodenal ulcer may occasionally erode into the common bile duct and form a choledochoduodenal fistula. Such a fistula occurring simultaneously with a pancreatic duodenal fistula is reported. The presenting features of these fistulas are those of the ulcer and confirmation of the fistula may be difficult, although use of endoscopic retrograde cholangiopancreatography has greatly facilitated their diagnosis. In this case both fistulas could be cannulated through the base of the ulcer. The majority of these fistulas heal spontaneously with intensive medical management. The remainder require surgery, and a conservative approach avoiding direct interference with the fistula should be adopted. Drainage procedures are rarely required and once closed the fistulas usually cause no further problem.

Biliary Fistula↗
PubMed1986

For how long can the liver tolerate ischaemia?

In this study the ability of the normal liver to tolerate normothermic ischaemia was assessed. The survival rate in pigs after 3, 6 and 12 h of normothermic hepatic ischaemia was 71, 46 and 0%, respectively. A patient who survived after inadvertently being subjected to 90 min of normothermic hepatic ischaemia is also presented. These findings suggest that the 'safe period' for liver blood flow occlusion could be extended beyond 1 h.

Animals↗
PubMed1986

Results of treatment in immune thrombocytopenia.

One hundred and forty-eight adults with immune thrombocytopenia attending a single institution between 1971 and 1981 were analysed retrospectively and observed for a minimum of three years. Prednisone was administered to 134 patients (90 per cent) in whom a peak platelet count occurred at a median of eight days, at which time four distinct patterns of response became evident: 20 patients (15 per cent) achieved complete remission with platelet counts greater than 200 X 10(9)/I, and of these 13 relapsed; 46 (34 per cent) had incomplete remission with platelet counts between 100 and 200 X 10(9)/I, and of these 38 relapsed; 22 (17 per cent) had a partial remission with platelet counts between 50 and 100 X 10(9)/I, and 14 have relapsed; the remaining 46 (34 per cent) failed to respond to prednisone. The addition of cytotoxic drugs for patients who relapsed or failed to respond to this agent was uniformly ineffective with the spleen in situ. One hundred and two patients underwent splenectomy without mortality, and peak platelet counts were achieved at a median of two days after the operation. Forty-one patients (40 per cent) achieved complete remission and four have relapsed; 36 (35 per cent) achieved incomplete remission and five have relapsed; 18 (18 per cent) had a partial remission and two have relapsed; treatment failed in seven (7 per cent). Eleven of the post-splenectomy patients relapsed in a median of four months. Together with the seven who failed to respond (n = 18), a subgroup of 17 was treated with immunosuppressive regimens including prednisone, azathioprine, cyclophosphamide or vincristine. Ten achieved stable although incomplete remissions, with platelet counts between 50 and 200 X 10(9)/I. We suggest that the treatment of immune thrombocytopenia in the adult initially should be a course of prednisone, from which complete remission rate will be 4.7 per cent and further incomplete remissions of 5.5 per cent and partial remissions of 8.5 per cent can be anticipated; no correlation was demonstrable with the duration of symptoms and response to prednisone. Symptomatic patients and those requiring unacceptable doses of adrenocorticosteroids should then proceed to splenectomy, when an overall response rate of 93 per cent is possible. A relapse rate of 11 per cent may require a limited course of immunosuppressive treatment, which is likely to be effective in approximately 75 per cent of these individuals.

Adolescent↗
PubMed1986

Factors influencing prognosis in carcinoma of the stomach.

Prognostic factors were prospectively sought in a consecutive group of 223 patients with carcinoma of the stomach observed for a minimum of seven years. Age, race and mode of presentation did not influence survival time. Statistically improved seven year survival rates were observed in females (p less than 0.01) and patients with several features: symptoms lasting more than six months (p less than 0.01); absence of an abdominal mass (p less than 0.01); T1 versus T3 Stage of disease (p less than 0.001); absence of nodal involvement (p less than 0.01) and when curative resection was possible (p less than 0.01).

Adult↗
PubMed1985

Axillofemoral bypass. A 2-decade experience reviewed.

A retrospective study of axillofemoral bypass performed at Groote Schuur Hospital over a period of 2 decades was undertaken to analyse the results and to re-examine current criteria for patient selection. During this period 109 patients underwent surgery. The primary indication was critical ischaemia (in 88% of cases). Operative mortality was 6,4%. Graft thrombosis and sepsis were identified as the major reasons for graft failure. Overall graft patency at 3 years was 43% and at 5 years 30%. Successful graft thrombectomy improved the overall cumulative patency rate at 5 years to 43%, and patient survival in the same period was 56%. Modern advances in the assessment of anaesthetic risk together with improved postoperative intensive care have allowed more patients who in the past would have been considered candidates for axillofemoral bypass to undergo direct aortic reconstruction. While the results of axillofemoral bypass are inferior to those of aortic grafts, the technique remains a valuable method of limb salvage for the poor-risk patient and a life-saving treatment for aortic graft sepsis.

Adult↗
PubMed1985

VP-16-213 in the treatment of stage III and IV diffuse large cell lymphoma.

Between 1975 and 1979, 81 consecutive patients with clinical Stage III or IV diffuse large cell lymphoma were randomized to prospectively receive the epipodophyllotoxin VP-16-213 as a single agent (Group 1: n = 25), or an equivalent quantity of the same drug combined with either cyclophosphamide (Group 2: n = 24), or doxorubicin (Group 3: n = 32). In previously untreated patients complete remission rates were 55% for Group 1, 29% for Group 2, and 62% for Group 3, with further partial remission in 22%, 12%, and 13%, and overall median survival for the three groups being 19 months, 5 months, and 19 months, respectively. There was no difference between Group 1 and Group 3, whereas the cyclophosphamide-containing regimen (Group 2) was clearly inferior (P less than 0.01). Survival was adversely affected by failure to achieve complete remission, prior chemotherapy, and the presence of high bulk disease. No statistically significant correlation could be demonstrated between survival and histologic subtype, differences between Stage III and IV disease, and invasion of either the bone marrow or gastrointestinal tract. The epipodophyllotoxin VP-16-213 is an active agent in patients with advanced stages of diffuse large cell lymphoma. The inferior results obtained when combined with cyclophosphamide remain unexplained. The inclusion of previously treated patients in the series suggested a superiority for combining the epipodophyllotoxin VP-16-213 with doxorubicin, since a higher percentage achieved complete remission, median duration of survival was longer, and a great number of individuals remain disease-free. When re-analysed excluding previously treated patients, these differences are no longer evident and the combination is not statistically superior to the epipodophyllotoxin alone.

Alopecia↗
PubMed1985

Multiple endocrine neoplasia type I.

During the 13-year period 1970-1983 only 7 cases of multiple endocrine neoplasia type I (MEN I) were seen at Groote Schuur Hospital, suggesting that the associated gene is rare in this area. Only 1 of these patients was black. Endocrine associations were as follows: hyperparathyroidism--6 cases, pituitary hypersecretion--6 cases (3 each involving growth hormone and prolactin), and pancreatic hypersecretion--3 cases (2 of gastrinoma and 1 of insulinoma). The presenting features were predictably diverse and depended on the component which manifested first. There was little difficulty in reaching a diagnosis on routine investigation. All patients with hyperparathyroidism underwent a 3 1/2-gland parathyroidectomy as the first treatment procedure, normocalcaemia being achieved in 5 cases, but persistent hypercalcaemia in the 6th suggested a supernumerary gland. A pituitary adenoma was removed in 4 cases, but persistent prolactinaemia necessitated bromocriptine therapy in 3. Successful distal pancreatectomy was undertaken in a patient with insulinoma and a patient with gastrinoma, and a further patient with gastrinoma awaits surgery. The overall prognosis in cases of MEN I appears to depend on the most aggressive component, often the pancreatic lesion; our patients have run a surprisingly benign course with only 1 late death, from hypertensive heart disease.

Adult↗
PubMed1985

Survival after local treatment for early breast cancer.

A 10-year survival rate of 82% was found in 517 women with early localized breast cancer (pathological stage T1-2N0M0) who had been treated with local therapy alone (total mastectomy and axillary clearance). Factors influencing survival were tumour size (T1 versus T2) and age; patients older than 50 years fared better than younger patients at 5 years but this advantage had disappeared at 10 years. Receptor status influenced disease-free survival, but not survival. Recurrence developed in 93 patients--systemic in 46 and local in 47. Support for the contention that all breast cancer is systemic was thus not found at 10 years, and the value of local therapy alone in node-negative women was endorsed.

Adult↗
PubMed1985

Splenic pathology in immune thrombocytopenia.

Splenic pathology was analysed in 73 patients with immune thrombocytopenic purpura who underwent splenectomy for bleeding that had been resistant to adrenocorticosteroids. The mean splenic weight was 100 g. The only notable macroscopic feature was the prominence of Malpighian corpuscles in 15 cases. Microscopic examination showed formation of germinal centres in the lymphoid tissue of the white pulp in 40 cases, prominence of the histiocytes in the red pulp in 18 cases, and infiltration with neutrophils in the same area in 49 cases. Myeloid metaplasia throughout the splenic tissue was minimal in 58 cases, moderate in 15, and extreme in two. No distinguishing features were found in the spleen from patients who had not received previous immunosuppressive treatment (n = 3), those treated with prednisone (1 mg/kg/day) for a median of 14 days (n = 62), or those who had received the same dose of prednisone and additional azathioprine or cyclophosphamide (2 mg/kg/day) for a median of four weeks (n = 8). No correlation could be shown between histological features and the age of the patient or titre of antiplatelet antibodies. Similarly, no distinguishing features were found in patients with associated systemic lupus erythematosus (n = 8), hyperthyroidism (n = 6), immune haemolysis (n = 3), or recent viral illness (n = 3).

Adrenal Cortex Hormones↗
PubMed1984

Unusual response of lymphocytic lymphoma (not hairy cell leukaemia) to splenectomy without chemotherapy.

An unusual period of prolonged disease control after splenectomy without chemotherapy was achieved in 3 cases of B-cell lymphocytic lymphoma with pancytopenia, massive splenomegaly, minimal lymphadenopathy and circulating hairy cells. The finding of distinctive histopathological features in the bone marrow, lymph nodes and splenic tissue enabled this unusual condition to be characterized and differentiated from hairy cell leukaemia, which may have similar presenting features and in which response to splenectomy is generally good.

Aged↗
PubMed1984

Malignant tumours of the breast. Frequency distribution by age, race and stage at Groote Schuur Hospital, Cape Town, 1971-1981.

During the 11-year period 1971 - 1981, 2215 new female patients with breast cancer were seen at the Groote Schuur Hospital Breast Clinic, Cape Town. The mean age at presentation of White patients was similar to that in most Western countries, but the disease was seen at an earlier age in Coloured and Black patients. Coloured and Black patients also presented with more advanced disease than White patients. There was, however, a progressive overall trend over the 11 years towards presentation at an earlier stage of the disease.

Adolescent↗
PubMed1984

Phaeochromocytoma and acute cardiovascular death (with special reference to myocardial infarction).

The causes of death, as determined by autopsy, in 10 patients dying from the acute effects of phaeochromocytoma were myocardial infarction (five patients), left ventricular failure (two patients), cerebral haemorrhage (two patients) and circulatory collapse with malignant phaeochromocytoma (one patient). Most patients died shortly after admission during the course of a fulminant cardiovascular illness and the underlying tumour was unsuspected in eight instances. The clinical features and post-mortem cardiovascular findings are reviewed.

Adrenal Gland Neoplasms↗
PubMed1984

The relationship between gastric carcinoma and gastric juice lactate (L + D) and lactate dehydrogenase.

L-Lactate, D-lactate, and lactate dehydrogenase (LDH) levels were measured in the resting gastric juice of 73 patients and mean levels were found to be significantly higher in patients with gastric carcinoma than in those with benign gastric ulcer or those with normal stomachs. Raised levels of gastric juice L-lactate (greater than 1.3 mmol/l), D-lactate (greater than 0.15 mmol/l), and LDH (greater than 55 IU/1) were seen in 14 of 27 patients with carcinomas, two of 15 with benign ulcers, and six of 31 controls. Both L/D-lactate and LDH levels correlated with tumor size and depth of invasion. While six problem cases with large gastric lesions were correctly diagnosed using these indices, there was only poor sensitivity and moderate specificity, as early cancers had normal L/D-lactate and LDH levels, and these indices were raised in a significant number of controls. Thus while it is of interest that L/D-lactate and LDH are elevated in the gastric juice of patients with gastric carcinoma there appears to be little optimism for using these indices in the early diagnosis of gastric neoplasia.

Adult↗
PubMed1984

Angiosarcoma of the breast.

We report a case of the rare angiosarcoma of the breast, illustrating the not infrequent error of making the initial incorrect diagnosis of benign haemangioma and the subsequent relentless progression of the lesion despite mastectomy, external beam and interstitial radiotherapy, and chemotherapy.

Abdominal Neoplasms↗