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J M Northover

Publications and source records attributed to J M Northover.

At least 55 records · Page 3Linked to original sources
PubMed1991

Anal human papillomavirus infection: a comparative study of cytology, colposcopy and DNA hybridisation as methods of detection.

OBJECTIVE: To compare anal cytology, colposcopy and DNA hybridisation as methods of detecting anal HPV infection. SUBJECTS AND DESIGN: Patients attending: (1) a genitourinary medicine (GUM) clinic with ano-genital warts; (2) a surgical out-patient department with anal fissure or haemorrhoids were examined for evidence of anal HPV infection. RESULTS: Considering GUM clinic attenders, 17% (38/225) and 40% (90/225) had perianal or anal canal warts respectively. Colposcopic examination revealed anal acetowhite lesions without warts in 28% (63/225). Cytological evidence of HPV infection was found in 98%, 83%, and 90% of patients with anal canal warts, perianal warts and acetowhite lesions respectively. Anal intraepithelial neoplasia (AIN) was documented in 22% of patients with anal canal warts compared with 6% with perianal warts (p less than 0.01). HPV DNA was detected from the anal brushings of 71%, 50%, 32%, and 29% of patients with anal canal warts, perianal warts, acetowhite lesions and a normal anal examination respectively. HPV type 6/11 was detected in the majority of HPV positive samples. Considering surgical out-patient attenders with no history or signs of anal warts, 25% showed cytological evidence of anal HPV infection and HPV DNA was detected from anal brushings in 3% (2/71). CONCLUSION: Anal examination with the colposcope is a useful method for detecting subclinical HPV infection. Anal cytology may prove helpful for detecting AIN, however, since koilocytosis was rarely seen, the specificity of the cytological criteria for anal HPV infection in the absence of AIN is uncertain. DNA analysis of anal brushings proved only moderately sensitive.

Adult↗
PubMed1990

Male homosexuality, HIV infection and colorectal surgery.

The sexual practices of male homosexuals may lead to the development of a wide variety of colorectal and perianal diseases. This review describes the pathogenesis of these conditions, their management, and the influence of HIV infection on these conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Is there a preference for different ways of performing faecal occult blood tests?

Low compliance with faecal occult blood screening reduces the power of clinical trials, potential benefit, and efficiency. It has been proposed that the faecal manipulation required to perform conventional guaiac based tests may be an important factor in low compliance. The aim of this study was to evaluate whether use of a new method (vehicle) of stool collection for the faecal occult blood guaiac test would be preferred to the established standard. A novel self-interpreted test, Early Detector (ED), requires the subject to apply a guaiac/peroxide spray to a stool sample collected simply by wiping the anus with a specimen pad. To determine whether this method would be preferred to the stool manipulation required by Haemoccult (HO) and to compare test validity, employees at a London company were invited to use both tests. Eight-hundred and fifty-seven subjects were shown both tests. Before use, 48% indicated a preference for the method of Early Detector; 24% chose Haemoccult (p less than 0.001), while 28% indicated no immediate preference. Seven-hundred and one performed both tests. After use, 74% preferred ED; 5% preferred HO (p less than 0.001); 21% had no preference (NP). The preference for the ED test method was consistent by sex categories, age groups and occupational class. Logistics, aesthetics, and immediacy of results were the main reasons indicated for choosing ED. Whether the preference for ED could result in higher compliance remains to be proven. Its high positivity (14%), however, would preclude its use as a sole test to determine the need for endoscopic and/or radiologic investigation in the screened patient.

Adult↗
PubMed1990

Clinical and pathological correlates of HPV type 16 DNA in anal cancer.

The aetiology of anal squamous cell carcinoma (SCC) has recently been associated with a sexually transmissible agent--human papillomavirus (HPV) type 16. In this study clinical and pathological data from a prospective series of 67 anal SCC collected over a three year period were compared with the HPV type 16 DNA content of these tumours to determine whether any of the clinical or histological parameters might predict HPV DNA content in a tumour specimen. Of twelve clinicopathological variables examined none was significantly correlated with HPV DNA content at the p = 0.01 level.

Adult↗
PubMed1990

Anal cancer and marital status.

Anal cancer is a rare tumour in Britain and its epidemiology has not previously been studied in this country. Several studies from the United States have shown an association between single marital status at the time of tumour registration (as a marker of male homosexuality in these populations) and the incidence of anal cancer. This study has used registry information on martial status for anal cancer and for colon cancer (controls) from the Thames, West of Scotland and West Midlands Cancer Registries. The registry data on marital status was validated using death certificate information. The relative risk of developing anal cancer was found to be significantly increased in single men for all three registries individually and for the combined data sets (OR 2.2' 95% CI 1.8-2.8). This accords with the findings of similar studies in the United States and supports the hypothesis that a sexually transmissible agent may be involved in the aetiology of anal cancer. For women, being unmarried was found to be protective against anal cancer in the combined data sets (OR 0.6; 95% CI 0.5-0.8).

Adult↗
PubMed1990

Prognostic factors in anal squamous carcinoma: a multivariate analysis of clinical, pathological and flow cytometric parameters in 235 cases.

Clinical, pathological and flow cytometric parameters have been analysed by univariate and multivariate analysis to define those parameters of important prognostic influence in 235 cases of surgically treated squamous carcinoma of the anus and perianal skin. Patients had been treated by anorectal excision (166 patients) or by local excision (69). Analyses were carried out on five data sets--the two surgical subgroups, two groups distinguished by site of tumour and on all 235 patients. Univariate analysis showed many parameters to be of prognostic influence, although histological typing of tumours into the more common histological subtypes was of no prognostic value. Parameters of independent prognostic significance in multivariate analysis were those indicating depth of spread, inguinal lymph node involvement and DNA-ploidy. In this study the subdivision of the rarer types of anal canal tumour, such as mucoepidermoid carcinoma, microcystic squamous carcinoma and small cell anaplastic carcinoma, was relevant confirming that these tumours have a poor prognosis. It is now felt that surgery should not be employed as primary treatment in most cases of anal cancer and the results of this study have to be interpreted with caution when applied to patients treated with radiotherapy with or without chemotherapy. Nevertheless, our findings suggest that the most useful prognostic information can be gleaned from accurate clinical staging and an assessment of DNA-ploidy status.

Adult↗
PubMed1990

DNA hybridisation of routinely processed tissue for detecting HPV DNA in anal squamous cell carcinomas over 40 years.

To study possible changes in the incidence of human papillomavirus (HPV) associated anal squamous cell carcinomas (SCC) a simple, rapid, and sensitive technique (alkaline hydrolysis) to permit DNA hybridisation from formalin fixed, paraffin wax embedded tissue was developed. The sensitivity and specificity of the technique were established by comparison with Southern blot analysis and in situ hybridisation on the same tissue specimens. Ninety tissue specimens in a single analysis were examined using this technique. Alkaline hydrolysis was applied to fixed tissue samples which showed a two-fold increase over the past 10 years in the percentage of anal cancers containing HPV type 16 DNA when compared with the previous 30 years using 207 cases of anal cancer collected over a 40 year period. This method has several advantages over the polymerase chain reaction as it is simple, relatively inexpensive, and may be widely applied to the detection and quantification of DNA sequences, including cellular oncogenes.

Anus Neoplasms↗
PubMed1990

99mTc radioimmunoscintigraphy of colorectal cancer.

The monoclonal antibody PR1A3 against a normal colonic columnar cell surface antigen has been labelled with 99mTc and used for imaging colorectal cancer. High uptake in undifferentiated cancer is seen. The tumour to mucosa ratio was up to 63:1 and the percentage of the injected activity in the tumour up to 1.7 X 10(-2%)g-1. As 99mTc is continuously available in a Nuclear Medicine Department, on receipt of a request the study may be completed within 24 h enabling radioimmunoscintigraphy to be used routinely in the management of patients with colorectal cancer.

Adenocarcinoma↗
PubMed1989

Anal and cervical intraepithelial neoplasia: possible parallel.

This study evaluated prospectively the use of an endoscope in examination of the anal canal for the detection of premalignant lesions. All patients underwent endoscopy and anal epithelial biopsy; the biopsy samples were examined histologically and human papillomavirus (HPV) DNA hybridisation was done. No evidence of anal intraepithelial neoplasia (AIN) was found in 20 control patients with anal fissure or fistula. Of 82 patients with anal HPV infection, 23 had evidence of AIN. The prevalence of AIN was significantly higher among homosexual than among heterosexual men (17 of 28 vs 1 of 26) with anal HPV infection. Of 28 women with anal HPV infection, 10 had cervical intraepithelial neoplasia (CIN); 5 of the 10 also had AIN, whereas no woman had AIN in the absence of CIN. The study shows that AIN occurs and can be diagnosed endoscopically in a manner similar to CIN. Further detailed prospective studies on the natural history of AIN and of groups at risk are required.

Adolescent↗
PubMed1989

Conservative proctocolectomy: a dubious option in ulcerative colitis.

Conservative proctocolectomy was performed for ulcerative colitis in 19 patients, Crohn's disease in three and familial adenomatous polyposis in one. Healing was uncomplicated in only three patients (13 per cent). Eleven developed an anal discharge and nine an infected pelvic haematoma despite peranal drainage. Fourteen patients developed pelvic sepsis and, despite surgical curettage in 11, none healed. Six of these patients have had the anal sphincter divided, with healing in only one, and the anal canal has been excised in two. Eleven patients have ultimately healed at a median time of 28 months and eight have persistent sepsis after a median period of 45 months. Two patients with sepsis have had a successful ileoanal anastomosis. Conservative proctocolectomy cannot be recommended as a definitive operation for ulcerative colitis even though it may permit a subsequent restorative procedure.

Adult↗
PubMed1989

Anal endosonography in the evaluation of perianal sepsis and fistula in ano.

Anal endosonography has been performed in 22 patients with fistula in ano and perianal sepsis and compared with the operative findings. Using a special hard cone attachment to a radial 7 MHz probe the examination was well tolerated, rapid and generally accurate, detecting two unsuspected foreign bodies and all seven complicated fistula in ano preoperatively.

Abscess↗
PubMed1989

Squamous cell carcinoma of the anus at one hospital from 1948 to 1984.

Two hundred and twenty-eight patients with anal carcinoma treated between 1948 and 1984 were reviewed. Of 145 with anal canal carcinoma, 118 were treated by total anorectal excision, nine by local excision and 13 by radiotherapy. Fifteen patients were inoperable. There were five postoperative deaths. Crude and cancer-specific survival rates of 123 patients treated 5 or more years previously were 58 and 64 per cent. These rates for patients undergoing total anorectal excision were 62 and 65 per cent, and local excision 87 and 100 per cent. Eighty-three patients had carcinoma of the anal margin. Of these, 55 were treated by local excision, 18 by total anorectal excision and 20 by radiotherapy. Eight patients were inoperable. Crude and cancer-specific survival rates for 72 patients followed for 5 years were 55 and 57 per cent with respective rates of 65 and 69 per cent after local excision and 36 and 40 per cent after total anorectal excision. The 5-year survival rate of 27 patients with TNM N1 stage was 48 per cent. Histological confirmation was obtained in only nine of these patients, however, but five (55 per cent) survived 5 years after block dissection or radiotherapy. Metachronous lymphadenopathy occurred in 25 patients. The 5-year survival rate in the 23 cases that were histologically confirmed was 35 per cent after block dissection (17 cases) and radiotherapy (four cases). Using a modification of Papillon's T classification for anal canal carcinoma, stage correlated with survival after combining T1 with T2 tumours and T2 with T3 tumours. Five-year survival rates in these groups were 60 and 54 per cent respectively. The TN M-UICC classification for anal margin carcinoma correlated with survival in a similar manner. The 5-year survival rate was 65 per cent for patients with T1 and T2 tumours and 33 per cent for those with T3 and T4 tumours.

Adult↗
PubMed1989

A prospective study of the use of 111In-labelled monoclonal antibody against carcino-embryonic antigen in colorectal cancer and of some biological factors affecting its uptake.

This prospective study of radioimmunoscintigraphy using 111In-labelled, C46, a monoclonal antibody against carcino embryonic antigen, CEA, was undertaken in 23 patients with colorectal cancer, 18 with primary carcinomas, 3 with recurrences and 2 with metastases. A sensitivity of 95% and an accuracy of 91% was found. New observations through the use of two administered doses of antibody and the analysis of surgical specimens showed that for the low dose of antibody (average 0.76 mg) tumour uptake was 1.14 x 10(-2)% of the injected dose per gram, whereas on the higher dose (average 4.67 mg) the average tumour uptake was 6.77% (same units) p less than 0.01. Thus a six-fold increase of antibody caused a six-fold increase in tumour uptake, but no change was seen in the tumour to mucosa ratio 4.8 +/- 0.5 (low dose) and 4.0 +/- 1.0 (high dose). A further observation was that well and moderately differentiated tumours took up about four times more than poorly differentiated tumours (p less than 0.05). It was also found that tumour free lymph nodes had a six-fold greater uptake than tumour involved nodes (p less than 0.05) confirming other work with anti-CEA monoclonal antibody. In conclusion, although biological factors influence its efficacy, 111In labelled C46 anti-CEA is a suitable radiopharmaceutical for the radioimmunoscintigraphy of colorectal cancer.

Adult↗