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Biomedical subjects

E Pihl

Publications and source records attributed to E Pihl.

At least 55 records · Page 3Linked to original sources
PubMed1981

Prognosis in relation to symptom duration in colon cancer.

Between 1950 and 1978 754 patients underwent operation by one of the authors for carcinoma of the colon. Follow-up data were available on 99 per cent. Tumour stage distribution did not differ significantly with increasing duration of symptoms. The proportion of curative to palliative operative procedures was unrelated to symptom duration. Cancer specific survival for the entire patient series was worse when symptoms had been present for less than 3 months compared with 3-6 months, 6-12 months or 12 months or more (P less than 0.001, P less than 0.02 and P less than 0.04, respectively). Cancer specific survival after curative resection was also worse in patients with a symptom duration of less than 3 months compared with 3-6 months or 12 months or more (P less than 0.02 and P less than 0.03, respectively). These results show that colon cancer patients in whom the diagnosis is made and operation performed after a short symptomatic period do not have less advanced tumours nor better survival prospects.

Adult↗
PubMed1981

Comparative results of surgical management of single carcinomas of the colon and rectum: a series of 1939 patients managed by one surgeon.

A comparative analysis has been made of the results of surgical management of single carcinomas of the colon and rectum in a series of 1939 patients treated by one surgeon. The data were prospectively collected, with 99 per cent follow-up. Cancer specific survival did not differ significantly between patients with colonic or rectal cancer. Survival prospects were better for women (P = 0.02) and for patients less than 40 years of age (P = 0.03). Survival was significantly related to tumour staging (P less than 0.002). Cancer specific survival was better after curative resection for colonic than rectal carcinoma (P = 0.003). Five-year survival for patients with colonic tumours was 76 per cent and for rectal tumours 69 per cent. The 10-year survival figures were 73 per cent and 51 per cent respectively. This difference was accounted for by a higher proportion of Dukes' stage C tumours in the rectum (P less than 0.001) and better survival prospects for colonic compared to rectal stage C1 tumours (P = 0.02). Sphincter-saving resections were performed in 64 per cent of rectal cancer patients managed by curative resection. Survival tended to be better than after sphincter-sacrificing operations. After palliative resection, median survival for colonic and rectal cancer was 14 and 13 months respectively. After palliative bypass operations the corresponding figures were 4 and 8 months.

Adenocarcinoma↗
PubMed1981

Disease-free survival and recurrence after resection of colorectal carcinoma.

Recurrence data from a series of 1,315 colorectal cancer patients managed by one surgeon with potentially curative resection are presented. Complete follow-up information was available on 1,287 (98%) patients. At the time of the last recurrences, 164 and 232 months for rectal and colonic tumours respectively, the long-time recurrence rate was significantly (P = 0.001) higher for rectal tumours (42%) than for colonic (33%). Although local recurrences tended to be more common in rectal than in colonic tumours (18% compared to 15%), only those in contiguity with the operative area were significantly (P less than 0.005) more common in rectal tumours. Systemic recurrences were also significantly (P less than 0.025) commoner for rectal tumours. The greater recurrence rates in rectal tumours were associated with significantly (P less than 0.001) higher incidence of stage C tumours shorter recurrence-free survival in rectal stage C tumours (P = 0.001) and higher incidence of pulmonary metastases (P less than 0.001).

Colonic Neoplasms↗
PubMed1981

Lymph node anti-tumour effector cell mechanisms in colorectal carcinoma.

Eighty lymph nodes from 61 cases of colorectal carcinoma were studied by in vitro microcytotoxicity assay. It was found that 25 nodes (31%) from 22 of these cases (36%) contained lymphoid cells which were cytotoxic against autologous carcinoma cells in vitro. Lymph node cells (LNC) were not cytotoxic against 51Cr chicken red blood cells (CRBC). This assay was used as an indicator of natural killer cell (NK) activity. Comparably, normal control peripheral blood lymphocytes (PBL) were cytotoxic against CRBC but not against colonic target cells obtained from surgical biopsy specimens. Fc receptor-bearing cells, monitored by cytotoxicity against antibody-coated CRBC, were detected in 50 and 60% of cytotoxic and non-cytotoxic LNC populations. The varying effects of E- and EAC-rosette fractionation and iron filing treatment of effector cells indicate that regional LNC cytotoxicity in colorectal carcinoma is a complex phenomenon, which, however, is predominantly a function of E-rosetting lymphocytes. Lymphocytes obtained from all regional nodes were capable of responding to phytohaemagglutinin (PHA). The relative proportion of T lymphocytes (E-rosetting cells) was significantly higher in those lymph node suspensions which were cytotoxic against colon carcinoma cells.

Adenocarcinoma↗
PubMed1981

Small-intestinal obstruction following resection for carcinoma of the rectum.

The incidence of small-intestinal obstruction requiring surgical relief following resection for a single carcinoma of the rectum in 1061 patients is reviewed. Forty-eight patients (4.7%) required surgical relief. There were no postoperative deaths. In 18 patients small-intestinal obstruction occurred within the first six weeks of resection. Each obstruction was related to postoperative complications, especially intraabdominal sepsis. In 30 patients the obstruction developed after this period and was due to bands and/or adhesions. The majority occurred within the first two years. The incidence of intestinal obstruction was similar after both curative and palliative resection. Extensive pelvic dissection did not influence the incidence. The paracolostomy lateral space was not closed in patients treated by abdominoperineal excision. There was no incidence of paracolostomy obstruction.

Female↗
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

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

Symptom duration and survival prospects in carcinoma of the rectum.

Between 1950 and 1978, 1,228 patients were operated upon by one of us for carcinoma of the rectum. Symptom duration data were available for 1,081 patients. Forty-five per cent of the patients had symptoms preoperatively for less than three months, 22 per cent for three to six months, 15 per cent for six to 12 months and 18 per cent for 12 months or longer. The frequency of major symptoms did not differ significantly with increasing symptom duration. Symptom duration was not related to sex, age, tumor site within the rectum or tumor stage distribution. The proportion of curative to palliative operative procedures performed was unrelated to the duration of symptoms. The cancer specific survival rate was better for the total patient series and for those treated by curative resection if symptoms had been present for 12 months or longer compared with those of less than three months' duration, p = 0.001 and p = 0.01, respectively. Survival prospects were also better for patients with symptoms of less than six months' duration compared with those of six months or longer, p = 0.01 and p = 0.04, respectively. These results indicate that earlier diagnosis during the symptomatic period of carcinoma of the rectum cannot be expected to improve cancer specific survival rates. They direct attention to the importance of preclinical diagnosis.

Adult↗
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

Mortality and morbidity of Crohn's disease and ulcerative colitis in Australia.

In Australia, between 1968 and 1977, the number of fatalities attributed to Crohn's disease increased significantly from 0.07/10(5) mean population (1968 to 1972) to 0.12/10(5) mean population (1873 to 1977). Over the same period, the mortality rate for ulcerative colitis was 0.23/10(5), with no increase. The ratio of the mortality rate for ulcerative colitis to that for Crohn's disease was similar in Australia to that in England and Wales, but the mortality rates for both diseases in Australia were approximately one-third of the corresponding rates in northern Europe and North America. Between 1959 and 1978 the relative frequency of public hospital admissions for Crohn's disease increased markedly in comparison with that for ulcerative colitis. A registry for inflammatory bowel disease should be established for monitoring epidemiological changes in Australia.

Adolescent↗
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↗
PubMed1980

Immunohistological patterns of carcinoembryonic antigen in colorectal carcinoma. Correlation with staging and blood levels.

Forty-four primary adenocarcinomas of the large bowel and 2 liver metastases were stained for carcinoembryonic antigen (CEA) in tissue sections by indirect immunofluorescence. All tumours were positive and showed either one or more of 3 different patterns--luminal; linear at surface of the tumour cells; cytoplasmic. In most cases (83%), two or all 3 patterns were seen in the same or in different parts of a tumour. The immunohistological staining was concordant with preoperative blood levels of CEA in 31 cases (67%) in that 26 tumours showed strong immunofluorescence associated with blood CEA above 2.5 micrograms/l, and 5 showed weak staining and blood CEA values less than 2.5 micrograms/l. However, in 7 strong staining was associated with low blood CEA, and in 8 weak staining was associated with high blood levels. The dissociation between histological and blood CEA findings in 1/3 of the cases, together with the marked variation within the same tumour and differences between one of the primaries and its liver recurrence, suggest that CEA immunohistology is of no better prognostic value than blood CEA levels. There was no association between CEA immunohistology and tumour staging or differentiation. However, blood CEA levels were significantly higher in tumours with extensive local or distant spread (stage D) and in poorly differentiated tumours.

Adenocarcinoma↗
PubMed1980

Regional lymph node and stromal immunomorphology in colorectal carcinoma and relation to tumour spread.

A quantitative morphometric study of lymphocyte patterns in the stroma and regional lymph nodes was made in 509 cases of colorectal adenocarcinoma and 17 non-invasive adenomas. An increase in the perivascular lymphocytes, and in the size of lymph nodes, germinal centres and paracortical areas was most obvious in 'localized' invasive tumours and significantly more in Dukes' stage B than in stage C. Stage C1, defined as cases where the primary tumours were confined to the wall but with lymph node spread, showed hardly any perivascular lymphocyte aggregates, although in the regional lymph nodes there was relative paracortical, i.e. T-lymphocyte, hyperplasia. It is concluded that the presence of cuffs of perivascular lymphocytes at the tumour edge, and the increased size of tumour-free regional lymph nodes together with the relative and absolute abundance of germinal centres (B-lymphocyte) and paracortical areas (T-lymphocyte), are stage dependent. This is most obvious in stage B. These morphological expressions of host immunoreactivity may well reflect favourable anti-tumour mechanisms.

Adenocarcinoma↗
PubMed1980

Mucinous colorectal carcinoma: immunopathology and prognosis.

A total of 519 colorectal carcinomas were examined for the presence or absence of mucinous differentiation by means of microscopical morphometry. Of these, 28% had objectively measurable amounts of mucinous tumour epithelium. Tumours with > 50% mucinous areas (14%) had significantly poorer prognosis than non-mucinous in stages A and C, while mucinous differentiation did not correlate with prognosis in stages B and D. Lymph nodes regional to mucinous tumours had significantly less paracortical response, and those with < 50% mucinous differentiation, significantly less perivascular lymphocyte cuffing at the tumour margins. These lymph node and stromal compartments are putative T-lymphocyte areas, and hence our findings suggest that mucinous tumours are either less stimulatory or perhaps inhibitory of cell-mediated immunity.

Adenocarcinoma, Mucinous↗
PubMed1980

Lymphoid hyperplasia: a major prognostic feature in 519 cases of colorectal carcinoma.

The size of the regional lymph nodes, germinal center, and paracortical areas, and the degree of perivascular lymphocyte cuffing (PLC) at the edges of 519 carcinomas of the large bowel have been analyzed microscopically and assessed quantitatively. Hyperplasia of these lymphoid areas, defined as relative or absolute size exceeding the median for the tumor stage, has been related to cancer-specific survival data for each of Dukes' Stages A, B, and C, and for disseminated disease commonly referred to as Stage D. Germinal center hyperplasia was associated with a major survival advantage in Stage B (P = 0.003) and in Stage C (P = 0.04) if present in tumor-involved lymph nodes. Paracortical hyperplasia related favorably to survival in Stages B and C; in Stage C such hyperplasia was most favorable if present in tumor-involved lymph nodes (P = 0.009). PLC related to favorable survival data only in Stage B. Lymphoid hyperplasia showed no correlation with survival in Stages A and D.

Adenocarcinoma↗