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Biomedical subjects

G A Kune

Publications and source records attributed to G A Kune.

At least 37 records · Page 2Linked to original sources
PubMed1990

Body weight and physical activity as predictors of colorectal cancer risk.

The associations between colorectal cancer and body weight (expressed as body mass index) and between colorectal cancer and physical activity were examined in 715 histologically confirmed cases of colorectal adenocarcinoma and 727 age- and sex-matched controls. The data were obtained from a large, population-based study, The Melbourne Colorectal Cancer Study, which was conducted in Melbourne, Australia. There was a statistically significant increase in the risk of rectal cancer but not of colon cancer in overweight and obese males but not in females. This association for males remained statistically significant after adjustment was made for dietary risk factors previously established for this study (Nutr Cancer 9, 21-42, 1987), with the exception of sodium intake, which produced a downward modification of the relative risk close to unity. The increased risk of rectal cancer in overweight and obese males was modified by beer intake, which was previously found to be a risk for rectal cancer in males in this study. Various levels of physical activity were not statistically significantly associated with the risk of colorectal cancer in either males or females. Also, the colorectal cancer risks associated with the body mass index were not significantly altered by adjustment for the physical activity level.

Adult↗
PubMed1990

Balloon dilatation of biliary strictures: experience and review of the literature.

Patients who develop strictures after repeated biliary surgery are a complex management problem. Reoperation in these patients, who may also have cirrhosis, portal hypertension and non-dilated ducts, is hazardous even in experienced centres. The new technique of percutaneous balloon dilatation has been used increasingly in such cases. A review of the literature and the experience with this technique in five patients with recurrent biliary strictures is presented. Its use is recommended in patients who present with recurrent problems when a previous biliary-intestinal anastomosis has failed as well as in those who develop stricture following multiple procedures involving the biliary system.

Bile Duct Diseases↗
PubMed1989

Surgical significance of the bile duct of Luschka.

In 20 post-mortem dissections, the subvesical bile duct of Luschka was noted in six specimens. Microscopic examination of ten other post-mortem gallbladders revealed small bile ducts on the gallbladder surface in five. Four cases of injury to the duct of Luschka during cholecystectomy are described and illustrated with cholangiographic and histological evidence. Post-cholecystectomy bile leaks from the drain tube, which closed spontaneously without sequelae, were noted in 9 per cent of 204 randomly selected cases and were regarded, at least in some, as being caused by a divided duct of Luschka. The practical significance of this duct during cholecystectomy is to keep close to the gallbladder wall during removal of the gallbladder, and to ligate a divided bile duct of Luschka if recognized at surgery.

Adult↗
PubMed1989

Serum levels of beta-carotene, vitamin A, and zinc in male lung cancer cases and controls.

The mean serum levels of beta-carotene and vitamin A in a multivariate analysis of data from 64 histologically confirmed male lung cancer cases were statistically significantly lower than those from 63 randomly selected male hospital controls, who were admitted for small surgical operations (p values for both beta-carotene and vitamin A less than 0.001). The mean serum levels of zinc were not statistically significantly different between cases and controls (p = 0.10). The levels of beta-carotene, vitamin A, or zinc were not statistically significantly influenced by either the extent of the cancer (p = 0.45) or the cancer cell type (p = 0.06). The possible biological significance of these findings is discussed briefly.

Adenocarcinoma↗
PubMed1989

Dietary and alcohol intake, smoking pattern, occupational risk, and family history in lung cancer patients: results of a case-control study in males.

In a case-control study of 71 consecutive new male cases of lung cancer and 71 male hospital control patients, previous dietary and alcohol intake, smoking pattern, occupation, dust exposure, and family history of lung cancer were investigated. The cases and controls were similar in age, country of origin, area of residence, and marital status. Using a frequency-based assessment of previous dietary intake, broad food groups were similar for cases and controls. Cases had a significantly lower intake of fish than controls did (odds ratio = 0.5, confidence interval = 0.2-1.0, p = 0.05). A protective effect for fish consumption in lung cancer has not been previously reported. The dietary intake of foods containing retinol and beta-carotene and the intake of alcohol were not significantly different between cases and controls. For cases, smoking duration was longer and the time since cessation for exsmokers was shorter, cigarette pack years were longer, and the number of cigarettes smoked per day was greater. The factors of occupation, dust exposure, and family history of cancer (including lung cancer) were similarly distributed between cases and controls.

Adenocarcinoma↗
PubMed1989

Dietary sodium and potassium intake and colorectal cancer risk.

In a large, comprehensive, population-based case-control study of colorectal cancer (The Melbourne Colorectal Cancer Study), a high intake of sodium was shown to be a statistically significant risk factor for rectal cancer in males (RR = 1.72, p = 0.01) and was close to statistical significance in females (RR = 1.58, p = 0.06). This was independent of previously described dietary risk factors and also independent of the previously described beer risk. A high intake of potassium was protective for both males and females, but this effect disappeared after adjustment was made for the previously described dietary risk factors. A high ratio of dietary potassium to sodium was a statistically significant protective factor in females for both colon and rectal cancer, and the significance of this effect was reduced after adjustment was made for the previously described dietary risk factor (RR for colon cancer = 0.70, p = 0.08; RR for rectal cancer = 0.67, p = 0.08). So far, no biological explanations are available for these associations, and while they are of obvious etiologic interest, they should be interpreted with caution.

Adenocarcinoma↗
PubMed1989

Children, age at first birth, and colorectal cancer risk. Data from the Melbourne Colorectal Cancer Study.

During 1980 and 1981, data were obtained on the number of children and age at birth of the first child in 675 cases of colorectal cancer and in 720 age-sex frequency-matched controls as part of a large epidemiologic study of colorectal cancer conducted in Melbourne, Australia. For colorectal cancer, the relative risk (RR) for those with one or more children compared with those with no children was statistically significantly lower than one (RR = 0.61, 95% confidence interval (CI): 0.45-0.81, p less than 0.001), and with simultaneous adjustment for number of children, there was an increasing risk with increasing age at birth of first child (RR = 1.03, with each increasing year of age at birth of first child, 95% CI: 1.00-1.05, p = 0.02). The relation between both the number of children and the age at birth of the first child and colorectal cancer risk was not statistically significantly different for males and females. The risk of colorectal cancer with respect to number of children and age at birth of the first child was unaffected by the potential confounding factors of age, occupation, previous diet, oral contraceptive use in females, and a family history of colorectal cancer. Since the protection against colorectal cancer associated with having children and with earlier age at birth of the first child was found to be similar for both males and females in the Melbourne study, a life-style factor, as yet unidentified, rather than a female hormonal factor, is postulated as the mediator of these effects.

Aged↗
PubMed1989

Klatskin tumours: a 20 year experience.

The management of 27 patients who presented with cholangiocarcinoma of the hepatic confluence over the past 20 years is reviewed, and the dramatic changes, both in accuracy of diagnosis and modes of treatment, are documented. All 27 presented with jaundice, three underwent laparotomy only, four had a T-tube inserted, one had a straight transhepatic tube inserted, seven U-tubes were placed and four patients underwent surgical resection. More recently, seven patients were drained percutaneously and a further patient was treated by an endoscopic stent. There were six postoperative deaths. Of the 24 who received active treatment, the mean survival was 8 months with a range of 0-40 months. The advantages and disadvantages of the various methods of diagnosis and treatment are discussed. The possible role of radiotherapy and chemotherapy are reviewed briefly.

Adenoma, Bile Duct↗
PubMed1989

Pre-operative albendazole therapy for recurrent hydatid disease.

Two patients with recurrent hydatid disease had a 1-month course of albendazole before surgery. In one case with a thick-walled host capsule, the scolicidal effect was incomplete, but, in the second case, in which thin-walled cysts were present, albendazole entered the cyst and was completely effective as a scolicidal agent. For thick-walled cysts, it may be necessary to use albendazole for more than 1 month pre-operatively in order to achieve a scolicidal effect.

Abdomen↗
PubMed1989

Surgical intervention in severe acute pancreatitis: 476 cases in 20 years.

During a 20-year period 1967-86, 476 consecutive cases of severe acute pancreatitis were managed by one surgeon (GAK) and the role and results of surgical intervention in this group were reviewed. Of the 173 cases undergoing surgery, 77 were laparotomies for diagnosis, seven for the excision of necrotic pancreatic tissue and 89 for postpancreatitis complications (18 pseudocysts, 53 pancreatic abscesses, one large bowel perforation, 17 patients with persistent obstructive jaundice and one case of acute haemorrhage into a cyst causing obstructive jaundice). There were 50 deaths (11%) of whom 38 died early in the course of the disease, two died following total pancreatectomy and 10 died as a consequence of a pancreatic abscess. Based on this experience and on the current understanding of this condition, the place of surgery in severe acute pancreatitis is discussed briefly.

Acute Disease↗
PubMed1988

Colorectal cancer risk, chronic illnesses, operations, and medications: case control results from the Melbourne Colorectal Cancer Study.

The associations between colorectal cancer risk and several chronic illnesses, operations, and various medications were examined in 715 colorectal cancer cases and 727 age/sex-matched controls in data derived from a large, comprehensive, population-based study of this cancer conducted in Melbourne, Australia. There was a statistically significant deficit among cases of hypertension, heart disease, stroke, chronic chest disease, and chronic arthritis and a statistically significant excess of "hemorrhoids" among cases, and all of these differences were consistent for both colon and rectal cancer and for both males and females. Although no statistically significant differences were found for other cancers, there were twice as many breast cancers among cases (16) than among controls and also there were 9 uterine cancers among cases and only 2 among controls. There was a statistically significant deficit among cases in the use of aspirin-containing medication and vitamin supplements, and this was consistent for both colon and rectal cancer and for both males and females. There was a statistically significant excess of large bowel polypectomy among cases. The modeling of these significant associations simultaneously in a logistic regression equation indicated that hypertension, heart disease, chronic arthritis, and aspirin use were each independent effects and consistent for both colon and rectal cancer for both males and females and also that these effects were independent of dietary risk factors previously described in the Melbourne study. The possible relevance of these findings towards an understanding of colorectal cancer risk and etiology is discussed.

Aged↗
PubMed1988

Current management of liver hydatid cysts: results of a 10-year study.

During the 10-year period July 1977 to June 1987, 23 patients were referred to one surgical department with hepatic hydatid cysts. Accurate diagnosis in all but one case was possible by hydatid serology (hydatid immunoelectrophoresis and enzyme-linked immunosorbent assay), and ultrasonography or computed tomography which showed the presence of daughter cysts. Endoscopic retrograde cholangiography demonstrated the presence of hepatic-duct hydatid cysts in one case. The probable source of the hydatid infection was identified in all 23 cases. The surgical management was standardized and included the use of a suction cone to prevent spillage; the closure of biliary communications under vision; 0.5% silver nitrate solution as the scolicidal agent; primary closure of the residual cavity without drainage; omentoplasty for infected cysts; and bile-duct exploration and operative choledochoscopy for choledochal hydatid cysts. Two hepatic wedge resections were performed for hydatid cysts in a Riedel's lobe, but formal liver resection, in which normal liver tissue was sacrificed, was not necessary. There was no mortality and there were no postsurgical hepatobiliary complications such as biliary fistulas, biliary sepsis or jaundice. Three (13%) recurrences were recognized; all three recurrences occurred about five years after the removal of hydatid cysts with numerous daughter cysts, which were located in multiple cavities in both lobes of the liver. Postsurgical surveillance for several years by annual clinical review, hydatid immunoelectrophoresis testing and ultrasonography is recommended.

Adult↗
PubMed1988

The role of chronic constipation, diarrhea, and laxative use in the etiology of large-bowel cancer. Data from the Melbourne Colorectal Cancer Study.

Life-long bowel habits of 685 colorectal cancer cases and 723 age/sex frequency matched community controls were investigated as one part of a large, comprehensive, population-based study of colorectal cancer incidence, etiology, and survival, The Melbourne Colorectal Cancer Study. Self-reported chronic constipation was statistically significantly more common in cases than in controls (P = .05). Three or more bowel actions per day were reported by more cases than controls but the total number of respondents in this subset consisted of only ten cases and two controls. Otherwise, the frequency and consistency of bowel motions was similarly distributed among cases and controls. Constipation disappeared as a significant risk when simultaneously adjusted for previously determined dietary risk factors, indicating that it is the diet and not the constipation that is associated with the risk of large-bowel cancer. Additionally, a highly statistically significant association (P = .02) was found with the risk of colorectal cancer in those who reported constipation and also had a high fat intake, a finding consistent with current hypotheses of colorectal carcinogenesis. It is concluded that chronic constipation, diarrhea, and the frequency and consistency of bowel motions, as well as laxative use, are unlikely to be etiologic factors in the development of colorectal cancer. Self-reported chronic constipation is a marginally significant indicator of excess risk of large-bowel cancer and may be used as one of the indices in the screening of individuals for this cancer.

Cathartics↗
PubMed1988

Large bowel cancer after cholecystectomy.

In a large, population-based case control study of colorectal cancer, 65 of 715 patients and 57 of 727 control subjects had a previous cholecystectomy (chi-square = 0.6, relative risk 1.18, 95 percent confidence interval 0.81 to 1.70, p = 0.45). There was no statistically significant association between previous cholecystectomy and the risk of colorectal cancer, colon cancer, right colon cancer, any of the subsites of colon cancer, rectal cancer, age, or sex. Although there is some evidence from other studies of an association between previous cholecystectomy and right colon cancer in women, this may have resulted from confounding symptoms. Based on the present evidence, we believe that previous cholecystectomy is unlikely to be a risk factor for colorectal cancer.

Aged↗
PubMed1988

Percutaneous extraction of retained common bile-duct stones via the T-tube track.

A total of 86 procedures were performed in 58 patients referred in the postoperative period, for percutaneous stone extraction through the T-tube track. In 43 patients, the stone or stones were extrahepatic, intrahepatic in nine, and both intrahepatic and extrahepatic in six patients. Of the 58 patients with residual bile-duct stone(s), 48 (83%) were treated successfully by percutaneous removal, seven (12%) had an endoscopic sphincterotomy following unsuccessful T-tube track extraction, one (2%) had a re-operation and two (3%) remain with residual stones. No major complications occurred in this series. In contrast to endoscopic sphincterotomy, percutaneous T-tube extraction of retained bile-duct stones is associated with no mortality and low morbidity and is advocated as the procedure of choice in the presence of a T-tube.

Adult↗
PubMed1988

Perianal Paget's disease.

An early case of perianal Paget's disease is described in a 59 year old female. Literature search revealed 57 documented cases up to 1987. Diagnosis is suspected on clinical features and needs to be always confirmed by biopsy with routine stains, and, in doubtful cases, also by electron microscopy and immunohistology. The extent of the primary disease and the presence of an associated adnexal or anorectal cancer must be established. Wide surgical excision of the primary lesion, preferably with frozen section examination of the excised margins and undersurface, is the preferred treatment. Associated adnexal or anorectal cancer is treated on merit. Recurrent disease is managed by further excision, topical chemotherapy and/or laser therapy. Prognosis depends on the extent of the primary lesion, on the adequacy of the primary excision, and on the presence of an associated adnexal or anorectal cancer. In apparently cured cases, long-term surveillance is recommended.

Biopsy↗
PubMed1988

Percutaneous drainage of subphrenic biliary collections using a Ring-McLean sump catheter.

This communication reports three consecutive cases of subphrenic biliary collections, resulting from biliary procedures. All were successfully treated percutaneously using a 16 French Ring-McLean sump drainage catheter without the need for secondary surgical intervention. Although percutaneous drainage of fluid collections is now commonplace, this is the first reported use of this drainage catheter for subphrenic biliary collections.

Adult↗