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Biomedical subjects

J K Ritchie

Publications and source records attributed to J K Ritchie.

At least 73 records · Page 4Linked to original sources
PubMed1977

Cancer in colitis: assessment of the individual risk by clinical and histological criteria.

The cancer risk among 229 patients with extensive ulcerative colitis observed during January 1, 1966 to February 29, 1976 is correlated with the length of history and the histological findings in rectal and colonic biopsies. Five patients are known to have developed carcinoma. No carcinoma was observed in 578 patient years of follow-up within 10 years of onset of the colitis, but the risk in the second decade was approximately 1 in 200 patient years and in the third, 1 in 60 patient years. Severe epithelial dysplasia was rare and found in 32 biopsies from 13 patients. No carcinoma has occurred during the period of follow-up in patients without dysplasia. It has not been possible to follow the development of dysplasia in sequential biopsies. Seven patients with consistent severe dysplasia on biopsy have been treated surgically; carcinoma confined to the bowel wall (Dukes' A) was found in 4. A scheme of management for patients with extensive colitis, including regular rectal and colonic biopsies, is proposed. Our results suggest that such a program will isolate a small group of patients who require surgical treatment for established precancerous change or carcinoma with a high likelihood of cure.

Biopsy↗
PubMed1976

Primary suture of the perineal wound following rectal excision for adenocarcinoma.

A statistical analysis of the correlations between a number of factors, including age, tumour pathology and surgical management, and the results of primary suture of the perineum after excision of the rectum for adenocarcinoma in 63 males is presented. An unsuccessful outcome was related to the extent of the dissection either necessitated by advanced tumour or resulting from excision of the coccyx. A successful result was associated with small tumours and preoperative antibacterial treatment. Topical antibacterial treatments, topical mercuric perchloride and the drainage route did not appear to affect the outcome.

Adenocarcinoma↗
PubMed1976

The results of surgical treatment for carcinoma of the rectum of St Mark's Hospital from 1948 to 1972.

The surgical treatment of 3163 patients seen at St Mark's Hospital with a single adenocarcinoma of the rectum in the years 1948-72 is described and the results analysed. In 2948 patients (93-2 per cent) the primary tumour was removed. The operative mortality fell from 7-0 per cent in the years 1948-52 to 2-1 per cent in 1968-72. The proportion of restorative operations has risen steadily over the years to a level of 41-1 per cent in the years 1968-72. There were 2410 operation survivors in the years 1948-67. The crude 5-year survival rate in the whole group was 47-1 per cent (corrected figure 56-7 per cent), and 56-6 per cent (corrected figure 68-4 per cent) for the 1931 survivors of radical operations. Comparison of results for patients surviving radical synchronous combined excision and radical anterior resection shows a significant difference in the two groups: in the former the crude 5-year survival rate was 52-7 per cent (corrected figure 63-8 per cent), and in the latter group the respective figures were 66-7 and 79-4 per cent. A higher proportion of Dukes' A and B cases and of low grade tumours are shown as the pathological background to the more favourable prognosis for patients surviving radical anterior resection.

Adenocarcinoma↗
PubMed1976

Proctocolitis and Crohn's disease of the colon: a comparison of the clinical course.

This study suggests that proctocolitis is an illness with an acute and potentially dangerous onset but which appears to become less severe after survival for one year, whereas Crohn's colitis tends to be a more chronic and progressive illness over several years with a greater need for surgical treatment and a greater tendency to anal complications.

Adolescent↗
PubMed1976

Crohn's disease of the distal large bowel.

This study describes the clinical features and management of 80 patients with Crohn's disease affecting initially only the rectum with or without involvement of the sigmoid colon. Most patients were treated medically, and the various measures used are considered; the cumulative probability of completing five years under conservative management was 60% among survivors. The related mortality was very low and confined to patients treated surgically; with 655.24 patient-years of follow-up the number of observed deaths was lower than the number expected from all causes. Since this distribution of the disease is usually seen in older patients and carries a favourable prognosis, it it suggested that it should be considered as a well-defined variant of the condition.

Adrenal Cortex Hormones↗
PubMed1975

The complications of synchronous combined excision for adenocarcinoma of the rectum at St Mark's Hospital.

The complications of synchronous combined excision of the rectum for adenocarcinoma in 227 patients were analysed. Urinary retention with infection occurred in 78 patients (34-4 per cent) and was the commonest complication. There was a significant correlation between tumours involving the anterior quadrants of the rectum and urinary complications. Primary suture of the perineal wound with closed drainage was associated with a higher incidence of complications than open drainage. The cumulative risk of a paracolostomy hernia in the sixth postoperative year was approximately 33 per cent. Extraperitoneal colostomy gave some protection against paracolostomy herniation.

Adenocarcinoma↗
PubMed1975

Estimation of carcinoembryonic antigen in ulcerative colitis with special reference to malignant change.

The levels of plasma carcinoembryonic antigen (CEA) were estimated in 59 control subjects attending St Mark's Hospital and in 139 patients with uncomplicated ulcerative colitis. There was little difference in the CEA levels in the two groups. In the colitic patients, the actual CEA values could not be correlated with the age of the patient, the activity of the disease, the extent of bowel involvement, or the length of history. In addition, seven colitic patients with severe dysplastic changes in the rectal mucosa and seven patients with established carcinoma in colitis were studied. With one exception in each group, the CEA levels in these patients were within the range shown by the St Mark's Hospital control population.

Adult↗
PubMed1975

Assessment of severity in colitis: a preliminary study.

Clinical features, alone and in combinations of up to five, noted early in patients during 181 admissions to one hospital for treatment of acute colitis over five years, have been correlated with the success or failure of drug treatment as judged by death during medical treatment or the need for urgent surgical treatment. Many of the 56 clinical features studied were of no value in predicting the outcome of the attack. The four features of greatest predictive value were the maximum daily body temperature, the maximum daily pulse rate, the bowel frequency and plasma albumin. The simplest and most discriminating prediction at the end of the first 24 hours in hospital was obtained by combining observations on maximum body temperature and the number of stools passed. Serial observations of temperature or pulse rate over the first four days in hospital gave more prognostic information than observations confined to the first day. The predictive value of certain other features, such as x-ray appearances, is described. A simple classification of severity in acute colitis is proposed from these results as a basis for prospective testing in other hospitals.

Acute Disease↗
PubMed1974

Results of surgery for inflammatory bowel disease: a further survey of one hospital region.

Case records have been studied for the results of surgery in 294 patients operated on for inflammatory bowel disease during 1967-72 at 34 non-teaching hospitals within the North-east Metropolitan Hospital Region. All patients treated surgically for acute colitis and those treated for chronic disease by total colectomy were included.The postoperative mortality of the primary surgery was 23.7%. The mortality was 2.1% in patients treated by elective operation, 37.6% in patients coming to urgent operation, and 60.9% in patients treated by emergency operation. The three most important factors affecting the mortality were considered to be: increasing age of the patient, the presence of established colonic dilatation, and preoperative perforation of the colon.

Adult↗
PubMed1973

Non-restorative surgery in the treatment of Crohn's disease of the large bowel.

This study gives detailed information on the two principal groups of patients undergoing excisional surgery with a permanent artificial stoma for Crohn's disease of the large bowel. During the years 1952-71, 64 patients were treated by total proctocolectomy and ileostomy and 26 patients by excision of the distal large bowel and colostomy. In the group of patients undergoing proctocolectomy, there were two postoperative and six late deaths. Of the 56 patients alive at the end of the follow-up period (average length of follow-up 8.1 years), four had shown evidence of recurrent disease. In each case this occurred following a staged proctocolectomy and at, or immediately proximal to, the ileostomy: the shortest interval between surgery and recurrence was just under 10 years. AMONG THE PATIENTS TREATED BY EXCISION OF THE DISTAL LARGE BOWEL, THERE WERE TWO UNRELATED LATE DEATHS: with an average duration of follow up of 7.3 years, recurrent disease occurred in only one of the 24 patients alive at the concluding date for this study.

Adolescent↗
PubMed1971

Ileostomy and excisional surgery for chronic inflammatory disease of the colon: a survey of one hospital region.

Four hundred and fifty-three patients who underwent ileostomy and excisional large bowel surgery for chronic inflammatory disease at two teaching hospitals and 35 non-teaching hospitals within the North East Metropolitan Hospital Region during the years 1955-66 were surveyed through a study of hospital case records. The surgical results and complications are presented in part I; a study of the health of these patients after their discharge from hospital is made in part II in an attempt to answer the question posed by many ileostomists, ;Are we as healthy as other people?'

Adolescent↗