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Biomedical subjects

J W Fielding

Publications and source records attributed to J W Fielding.

At least 91 records · Page 5Linked to original sources
PubMed1984

Carcinoembryonic antigen (CEA) expression and heterogeneity in primary and autologous metastatic gastric tumours demonstrated by a monoclonal antibody.

The expression of carcinoembryonic antigen (CEA) in gastric malignancies has been assessed using a monoclonal antibody in an immunoperoxidase technique. Of 119 primary tumours examined, 92% reacted with the antibody. Metastases were available for 81 of the patients and 83% were CEA positive. A noteworthy observation was the detection of malignant cells in the lymph nodes of two patients, as a result of the presence of CEA, who were originally reported to be free of metastases. Of those patients whose primary tumours expressed CEA, 86% had at least one CEA positive metastasis. Two or more metastases were available from 60 of the patients and in 20% the secondaries were a mixture of positive and negative for CEA. Consequently, the CEA status of a single lesion does not enable confident prediction of expression in other metastases. In addition to variation between multiple lesions removed from the same patient phenotypic diversity of expression was observed between tumour cells of a given mass. Such distribution of the CEA detected by this monoclonal antibody may impose certain restrictions on its application. However, the high frequency of expression by gastric cancers indicate that it is a potentially useful antigen as a target for radiolocalisation or therapeutic agents.

Antibodies, Monoclonal↗
PubMed1984

Cis-diamminedichloroplatinum (DDP) as initial treatment of invasive bladder cancer.

Cis-diamminedichloroplatinum (DDP) was used as the initial treatment in a pilot study of 17 patients with biopsy-proven transitional cell carcinoma of the bladder. No patient had received any previous radiotherapy or chemotherapy. The clinical stages of the tumours were T2 (2 patients), T3 (13) and T4 (2). Before treatment the tumours were assessed by cystoscopy, biopsy, examination under anaesthesia (EUA), computed axial tomography (CT scan) and ultrasound. DDP was given at a dose of 100 mg/m2 intravenously with hydration using mannitol and saline. Each patient received three treatments at 3-weekly intervals. Twelve days after the third treatment, response was assessed by cystoscopy, biopsy, EUA, CT scan and ultrasound. Eleven of the 17 patients had a partial response. Survival was significantly increased in responders compared with non-responders. Seven patients had a low creatine clearance following treatment, 5 had audiograms showing evidence of ototoxicity and 2 developed leucopenia during treatment. This study confirmed the activity of DDP in bladder cancer and showed that it was active in producing a response in the primary tumour in 11 of 17 patients.

Aged↗
PubMed1984

Second-look laparotomy in the management of epithelial ovarian carcinoma: an evaluation of fifty cases.

Fifty patients with ovarian cancer had a second-look laparotomy performed after chemotherapy. Complete histologic response was confirmed in 12 patients, microscopic disease was found in 12 patients, and macroscopic disease was found in 26 patients. Fifteen patients with macroscopic disease had total tumor clearance at second look. Surgical response to chemotherapy was found to correlate well with disease volume at the onset of chemotherapy. The operation is a safe, accurate technique for assessing the ovarian cancer patient. The findings and outcome probably depend upon the timing of the procedure. Any survival benefit from the operation remains to be proved.

Adult↗
PubMed1984

Gastric remnant recurrence--detection and implications for the management of gastric cancer.

The ability of endoscopy to detect remnant recurrence of gastric cancer has been evaluated in patients, either as a follow-up procedure (17 patients) or after symptomatic referral (7 patients). Overall 15 out of 24 (62.5%) patients developed some form of recurrence. Fourteen out of 15 (94%) had local disease either alone or in combination with distant metastases. Remnant recurrence was observed in 11 of these and after excluding those referred with symptoms, the true incidence of remnant recurrence was 41.2%. Patients in the follow-up group had 'early' remnant lesions which were diagnosed sooner after surgery than in the symptomatic group who had 'advanced' remnant recurrences. The detection of premalignant histology occurred earlier in those who developed remnant recurrence and this short time interval could be used to predict recurrence. Despite the early diagnosis of remnant recurrence, resection of the remnant at second laparotomy was only possible in one patient as the majority had other sites of extensive recurrence. The implications for the management of 'early' and 'advanced' gastric cancer are discussed.

Adenocarcinoma↗
PubMed1984

Gastric histology and its relationship to entero-gastric reflux after duodenal ulcer surgery.

Thirty-six volunteers, asymptomatic 7 to 22 years after various operations for duodenal ulcer, were screened for enterogastric reflux by external scanning following injection of 99mTc HIDA; they also had endoscopy for measurement of the fasting juice pH, and multiple biopsies. In patients with a pH above 4 there was an association between a positive bile reflux test and the presence of pre-malignant changes in the gastric mucosa. Carcinoembryonic antigen in the gastric mucosa was found in all patients and was not, therefore, a useful screening test for stump cancer. Blind examination of two sets of endoscopic biopsies obtained 6 weeks apart in symptomatic patients with post-operative reflux gastritis showed that histological assessment remained reproducible. Gastric biopsies obtained from 16 patients before, and a year after, Roux-en-Y gastro-jejunostomy demonstrated that foveolar hyperplasia tended to regress after bile diversion.

Biopsy↗
PubMed1984

Hemi-replacement arthroplasty of the proximal humerus. A case report.

A ten-year-old girl underwent excision of a chondrosarcoma of the right proximal humerus with subsequent insertion of a prosthesis. Failure of the device occurred six years after operation, requiring revision to an identical but shorter prosthesis. This device failed 1 1/2 years later and was replaced by a fibular graft inserted in the humeral medullary canal. The fibular graft was removed 18 months later, resulting in a flail right shoulder. The mode of failure in each instance was anterior and superior dislocation of the hemiarthroplasties. Currently, ten years after the initial procedure, the patient is tumor free with a shortened functional right upper extremity.

Bone Neoplasms↗
PubMed1983

Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients.

One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.

Adult↗
PubMed1983

Management of faecal incontinence and results of surgical treatment.

Ninety-five patients have been referred for the assessment and treatment of faecal incontinence. Incontinence was associated with previous anal trauma in 49 cases: 13 occurred after vaginal delivery, 32 were associated with anal operations and in 4 severe perineal trauma occurred after road accidents. Other causes were: idiopathic incontinence in 18, persistent incontinence despite successful rectopexy for prolapse in 10, diabetic neuropathy in 5 and in 13 the cause was not identified. Conservative treatment by control of diarrhoea, physiotherapy or electrical therapy was often successful in patients with minor incontinence. Fifty-six patients have been treated surgically. Complete continence was achieved in 67 per cent of patients treated by postanal repair and in 61 per cent by sphincter reconstruction. We believe that postanal repair is the treatment of choice for idiopathic incontinence and incontinence after rectopexy or anal dilatation. Sphincter repair should only be performed with a covering colostomy and is the treatment of choice for recent or long standing division of the external sphincter ring.

Aged↗
PubMed1982

Bile diversion after total gastrectomy.

A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40--50 cm).

Bile Reflux↗
PubMed1981

Diagnosis and management of 528 abdominal aortic aneurysms.

Between 1960 and 1979 528 patients with abdominal aortic aneurysms presented to the university department of surgery. Of these, 222 (42%) were elective cases, 72 acute (14%), 174 had ruptured (33%), and four had had a spontaneous aortoduodenal fistula (1%). In all these patients resections were undertaken, but in another 56 patients (11%) the aneurysm was not resected. A review of these cases showed that 91% had symptoms at their first presentation; abdominal pain and backache being most common. The diagnosis could be established in 91% by the presence of pulsatile abdominal mass on clinical examination. The operative mortality for elective resection was 8%, for acute 19%, for ruptured cases 42%, and for spontaneous aortoduodenal fistula 50%. After successful resection the overall five-year survival was 65% by the life table method, and there was no significant difference between elective, acute, and ruptured cases. This five-year survival after resection compares favourably with the expected 76% survival of a similar normal population, and was considerably better than that for conservatively treated patients. As most cases have symptoms, and diagnosis may be established easily by routine physical examination in 91%, the prognosis for this condition could be considerably improved by increased awareness of its existence and early referral for treatment as an elective surgical procedure.

Acute Disease↗
PubMed1981

Traumatic spondylolisthesis of the axis.

A series of 123 patients suffering traumatic spondylolisthesis of the axis is reported. This lesion is associated with extension and axial loading injury, and there is a high incidence of injuries of the face or scalp and of associated fractures of the upper cervical spine. There is a low incidence of neurological injury, which seems paradoxical in the presence of what appears to be gross instability, but protection from extremes of flexion and extension may be adequate treatment. Union is usual regardless of displacement. Traction is a safe means of treatment, but early waking in a halo support reduces time in hospital without jeopardizing the result. Operation is needed only for chronic instability with or without pain, and anterior interbody fusion of C2--3 is than preferred in order to preserve rotation at the atlanto-axial joints.

Adolescent↗