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Biomedical subjects

O F Dent

Publications and source records attributed to O F Dent.

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

Frequency of intermediate admissions and place of death of patients with advanced colorectal cancer.

An analysis was made of the place of death and the degree of institutional support required following surgery in patients with colorectal cancer (CRC) who had distant metastases. There was a high incidence of intermediate admissions to an acute hospital, and most patients died in an acute hospital bed. The number of readmissions and the place of death were not influenced by the patients' age, sex, site of tumour or their home situation at the time of diagnosis. In view of the high demand for acute surgical beds, there is a need to develop more appropriate facilities to care for patients in the terminal phase of this disease.

Aged↗
PubMed1990

Rectal bleeding. Patient delay in presentation.

Patient delay in presentation of rectal bleeding has been identified as a factor in delayed diagnosis among patients with colorectal cancer. The aim of this study was to identify demographic or psychological factors, or beliefs or behaviors related to delay in presentation of rectal bleeding. In 93 patients presenting with this symptom to their general practitioner, delay ranged from 0 to 249 days with a median of 7 days; 27 (29 percent) delayed more than 14 days. Delay was unrelated to age, sex, ethnic origin, competence in English, length of schooling, social status, availability of social support, measured psychologic traits, and to the belief that the cause might be cancer. The proportions delaying more than 14 days were statistically significantly elevated among those who were not worried by the bleeding (47 percent delayed); those who did not regularly look at their feces or the toilet paper after use (37 percent); and those who took some other action before presenting to their general practitioner (43 percent).

Adult↗
PubMed1990

Current perspectives in staging large bowel cancer.

Today, a standardized method of staging that is internationally accepted is urgently needed for the management of patients with colorectal cancer. The use of a uniform, sensitive staging system would greatly improve case selection and avoid unnecessary bias when entering patients into adjuvant therapy trials. This would allow a more accurate evaluation of new treatment protocols and assist in the development of more effective follow-up programmes.

Colorectal Neoplasms↗
PubMed1989

The prevalence of serological markers for hepatitis B virus infection in Australian Naval personnel.

In order to determine the prevalence of hepatitis B virus infection in Royal Australian Navy personnel and to formulate policies for their education, screening and vaccination, a voluntary survey was undertaken. Seven hundred and forty-eight subjects completed a questionnaire that provided details of age, sex, rank, ethnic origin, service abroad, length of service, history of tattooing, liver disease and blood transfusions. Serum was assayed by radioimmunoassay for the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (antiHBs) and antibody to hepatitis B core antigen (antiHBc). The presence of markers of hepatitis B virus infection was correlated with "risk factors" by means of the chi 2 test of independence. Fourteen (74%) of 19 personnel from the Pacific Islands, Asia and Africa who were excluded from analysis showed one-or-more such markers. The prevalence of any marker of hepatitis B virus infection was 4.4% (95% confidence interval [CI], 2.9%-5.9%). The individual markers HBsAg, antiHBs and antiHBc were found in 0.4% (95% CI, 0.1%-1.2%), 3.6% (95% CI, 2.2%-4.9%) and 3.9% (95% CI, 2.5%-5.3%) of subjects, respectively. The annual attack rate was estimated to be less than 1%. Factors which had a significant correlation with an increased prevalence of markers of hepatitis B virus infection included tattooing (especially if this had been performed in Asia), age, the duration of service and service abroad. Based on these data, and given the reduced cost of hepatitis B vaccines, vaccination now is considered worth while. A policy of vaccinating all personnel who may be required for service at sea, and others at risk, now is in effect. Educational programmes that are aimed at minimizing the risk of exposure to hepatitis B and other viral infections have been instituted.

Adolescent↗
PubMed1989

Postwar mortality among Australian World War II prisoners of the Japanese.

The impact of detention as a prisoner of war on postwar survival and disease-specific mortality was examined in Australian veterans of World War II. A random sample of 908 ex-prisoners and 797 other veterans of the same theatre of war, all of whom had returned to Australia alive, was traced over the 40 years since the war. The date and cause of death were recorded for those who were found to have died. By means of the subject-years method, the mortality of the prisoners of war was compared with that of the non-prisoners of war while the analysis controlled for the length of follow-up and the subject's age at the close of the war. The prisoners of war showed a higher over-all mortality rate than did the non-prisoners of war. This difference was pronounced in the period from five to 14 years after the war but diminished subsequently. There also was an indication that this effect varied with the subject's age at the end of the war: prisoners of war who were aged 25-29 years at that time had the highest mortality differential from non-prisoners of war, followed by prisoners of war who were aged 30-34 years. However, log-linear modelling, which controlled for age and the follow-up period, did not suggest that these mortality differences could be attributed to particular causes of death.

Adult↗
PubMed1989

Rectal bleeding. Do other symptoms aid in diagnosis?

It has been shown previously that it is difficult for a general practitioner to predict anal vs. colorectal sources of bleeding in patients presenting with rectal bleeding. The aim of the present study was to determine whether there are any aspects of such a patient's history or clinical features that strongly indicate bleeding from a colorectal cancer or polyp. One hundred forty-five consecutive patients, aged 40 years and older, who had complained of rectal bleeding to a general practitioner, were referred to a specialist for full colonic investigation. Among 15 symptoms and clinical features examined, few had any statistically significant association with the source of bleeding. There was an elevated probability of colorectal cancer (21 percent) in patients who had seen blood mixed with feces. Most bowel symptoms and clinical features are not helpful in deciding whether to proceed with full colorectal assessment in patients aged 40 and older who have rectal bleeding of recent onset.

Adult↗
PubMed1987

Evidence of hepatitis virus infection among Australian prisoners of war during World War II.

A sample of Australian male veterans of World War II was surveyed after 40 years. One hundred and seventy veterans had been held by the Japanese as prisoners of war and 172 veterans had served in southeast Asia but had not been taken captive (non-prisoners of war). A medical history was obtained and a physical examination undertaken. Blood was drawn and analysed for standard liver biochemistry and serological markers of hepatitis A and B virus (HAV, HBV) infections. The prevalence of immunoglobulin (Ig)G class antibodies to HAV was 95.2% in non-prisoners of war and 93.3% in prisoners of war. Only three cases of hepatitis B surface antigen (HBsAg) seropositivity were identified (two cases from the prisoner-of-war group). Thirty-six (21.8%) prisoners of war were seropositive for the presence of antibodies to HBsAg (anti-HBs) and 34 (20.0%) prisoners of war for that of antibodies to hepatitis B core antigen (anti-HBc), compared with 16 (9.8%) and eight (4.7%) of the non-prisoners of war, respectively (P = 0.002 and P = 0.0001, respectively). Those veterans who reported jaundice during World War II had a higher prevalence of antibodies to HBV. Among prisoners of war who were forced to work on the Burma-Thailand railway, 24.1% were seropositive for anti-HBc compared with 11.1% of the remaining prisoners of war (P = 0.048). It would appear that hepatitis B was common in prisoners of war but that those who survived 40 years were able to clear the virus and do not appear to have significant liver disease.

Asia, Southeastern↗
PubMed1987

Precursors of depression in World War II veterans 40 years after the war.

The impact of wartime stress and other psychosocial and health variables on depressive illness in the 40 years since the Second World War is examined in this study of Australian male prisoners of the Japanese and other veterans. A random sample of 170 surviving members of the captured Eighth Division of the Australian Army residing in Sydney in 1983 (POWs) was compared with a similar sample of 172 veterans who fought in Southeast Asia during the war but were not imprisoned (non-POWs). Multiple regression analysis involving nine predictor variables revealed that self-reported nervous illness during the war and depressive illness since the war had pronounced independent effects on current depression as measured by the Zung Scale. Being married and better educated had significant protective effects against depression for the non-POWs while being employed and having higher socioeconomic status were protective for POWs. A clear linkage was shown from wartime nervous illness to postwar depressive illness to present-day depression.

Aged↗
PubMed1987

The cost of resection for colorectal cancer.

The aim of this study was to determine the average total cost and component costs of the surgical management of colorectal cancer (CRC) in a large teaching hospital and to examine the relationships between cost and several characteristics of the patients. Data were compiled for 97 consecutive patients undergoing resection for CRC at Concord Hospital in 1979. The cost of the following components was calculated for each patient: (a) pre- and postoperative bed occupancy; (b) investigations; (c) operation; (d) anaesthetic; (e) prescribed drugs; (f) allied health services. The cost of bed occupancy was by far the largest item in the average total cost (72%), followed by the cost of investigations (11%). There was no correlation between pre- and postoperative bed occupancy and no patient characteristic had a statistically significant effect on pre-operative stay. Several factors were associated with prolonged postoperative stay including the number of clinical problems, operation for rectal as opposed to colonic cancer, having a two-stage procedure, surgical complications and wound infection. By far the greatest reduction in total cost could be achieved by reducing the length of postoperative stay.

Adult↗
PubMed1986

How important is rectal bleeding in the diagnosis of bowel cancer and polyps?

Overt bleeding from the anus is a common symptom of colorectal cancer but most frequently arises from a benign anal source. The aim of this study was to determine how successfully general practitioners and gastroenterologists could differentiate anal from colorectal sources of bleeding before full colonic investigation. 145 consecutive patients aged 40 years and over who had presented to a GP with rectal bleeding of less than 6 months' duration were referred to a specialist for total colonic investigation. The source of bleeding was diagnosed as colorectal cancer in 15 patients (7 stage A, 3 stage B) and polyps in 11. Of 63 patients in whom GPs predicted an anal source of bleeding only, 11 were ultimately found to be bleeding from a colonic or rectal source. The gastroenterologists (after rigid sigmoidoscopy) predicted an anal source of bleeding in 97, in 5 of whom the source was ultimately found to be colorectal. All patients aged over 40 who present with recent rectal bleeding should be referred for full colonic investigation.

Adult↗
PubMed1986

Bowel symptoms in an apparently well population.

The aim of this study was to determine the prevalence of various kinds of bowel behavior and symptoms thought to be indicative of colorectal cancer in people randomly selected from the community. A probability sample of 330 dwellings in the inner western suburbs of Sydney yielded 202 completed interviews with occupants aged 30 years and older. Eight percent reported annoying abdominal pain that had lasted for two weeks or more in the preceding six months, while 19 percent reported a feeling of incomplete evacuation at least once every two weeks. Blood on the toilet paper was reported by 14 percent and blood in the toilet bowl by 2 percent. Twenty-one percent said they always looked at their stool in the toilet bowl and 34 percent always looked at the toilet paper after using it, but 43 percent seldom or never looked at either their stool or the paper. Of the 75 who said they looked at their stool about half the time or more, two (3.1 percent) reported seeing blood during the preceding six months. Symptoms that may be associated with colorectal cancer are common in apparently well adults. Whilst this includes bleeding from the rectum in toto, it may not be true for blood seen specifically in the toilet bowl. Because this latter symptom has potential discriminating value, it may be worthwhile to promote public education encouraging people to inspect their stools regularly, and to visit their doctor if blood is seen.

Colonic Neoplasms↗
PubMed1986

An evaluation of the American Joint Committee (pTNM) staging method for cancer of the colon and rectum.

This study, using prospective data, compares the survival of 1011 patients who had a colorectal cancer resected at Concord Hospital between 1971 and 1983. The results are expressed both in terms of Australian clinicopathologic (CP) staging and the modified pTNM method proposed by the American Joint Committee for Cancer Staging and End Results reporting. The aim of the study was to determine which of the two staging methods gave the better guide to prognosis. The results indicate that pTNM does not add to information beyond that given by CP staging. We conclude that the pTNM classification is only partially able to separate patients into different survival groups; it is complicated and difficult to memorize, and does not give useful prognostic information beyond that provided by the simpler CP system.

Australia↗
PubMed1986

Prevalence of hemochromatosis in a random sample of asymptomatic men.

The prevalence of hemochromatosis was studied in 343 randomly selected male World War II veterans aged 58 years and older. Those men with a serum ferritin level of greater than 700 micrograms/l or a transferrin saturation of greater than 55% underwent liver biopsy. Hepatic iron concentration was assessed histochemically and by atomic absorption spectrophotometry. Histology was assessed blindly by one histopathologist. Of 21 veterans biopsied, four men had hemochromatosis, confirmed by venesection response, and the remaining biopsies all showed some histological abnormality. All four men with hemochromatosis had a transferrin saturation of greater than 55% while only three of the four had a serum ferritin level over 700 micrograms/l. The prevalence of hemochromatosis detected in this sample was 1.2%, which is higher than that suggested by overseas studies.

Aged↗
PubMed1986

The psychological effects of being a prisoner of war: forty years after release.

Forty years after the end of World War II, the authors compared a random sample of former Japanese-held Australian prisoners of war (POWs) with a group of non-POW combatants of the same era. The POWs were significantly more depressed than were the control subjects, but the two groups did not differ in prevalence of anxiety symptoms or alcohol problems. Apart from a higher rate of postwar duodenal ulcer in the POWs, the two groups had similar degrees of medical morbidity.

Aged↗
PubMed1985

Gastrointestinal morbidity among World War II prisoners of war: 40 years on.

A study of Australian male World War II veterans was conducted to assess clinically the gastrointestinal ill-effects which were present 40 years after the stress of internment as prisoners of war of the Japanese. A random sample of 170 surviving members of the captured Eighth Army Division resident in Sydney in 1983 (ex-POW) was compared with a similar sample of veterans who fought in Southeast Asia during the War, but were not imprisoned (non-POW). Duodenal ulcers and strongyloidiasis were more prevalent in the ex-POW group than in the non-POW group. The increased rate of duodenal ulcer (24.7%, compared with 10.5%; P = 0.0005) was confirmed by a higher proportion of ex-POWs currently taking cimetidine (9.0%, compared with 2.3%; P = 0.008). Strongyloidiasis had been found in 9.7% of all veterans, but in 15% of ex-POWs and in 19% of those who had worked on the Burma-Thailand railway. No other significant differences in gastrointestinal disease were found.

Aged↗
PubMed1985

Predictive value of rectal bleeding in screening for rectal and sigmoid polyps.

Overt rectal bleeding is a common symptom of colorectal cancer and polyps but also occurs in apparently healthy people. It is not known how often this represents bleeding from an undiagnosed rectal or sigmoid polyp or cancer. Three hundred and nineteen apparently healthy men aged over 50, selected by random sampling, were interviewed and underwent flexible sigmoidoscopy to at least 30 cm. Polyps of 10 mm or more in diameter were diagnosed in 12, one of whom also had an adenocarcinoma. Rectal bleeding during the previous six months was reported by 48, four of whom were found to have polyps; seven polyps and one cancer were diagnosed among the 271 who reported no rectal bleeding. Rectal bleeding had a specificity of 86%, a sensitivity of 33%, and a positive predictive value of 8% for rectal or sigmoid polyps or cancer. Restricting the analysis to those subjects who regularly inspected their stools did not improve the predictive value. Sigmoidoscopy in apparently healthy subjects with rectal bleeding will not result in the diagnosis of appreciable numbers of rectal and sigmoid polyps or cancers.

Gastrointestinal Hemorrhage↗
PubMed1985

A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer.

Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.

Adenocarcinoma↗