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Biomedical subjects

P Sherlock

Publications and source records attributed to P Sherlock.

At least 37 records · Page 2Linked to original sources
PubMed1981

Colon and rectal cancer: etiology and screening.

Our ultimate goal is primary prevention of colorectal cancer by delineating the etiologic factors in the pathogenesis of the disease and eliminating or modifying these factors. Further research is needed to accomplish this goal. In the meantime, early detection of colorectal cancer and its precursor lesions can be accomplished by methods currently available. Ultimately, a simple biochemical or immunologic test may become available which will identify individuals at high risk for colon cancer and may indicate that a very early lesion is present. This is the ultimate goal for secondary cancer prevention since the disease would then be discovered at a curable stage in almost all patients.

Barium Sulfate↗
PubMed1980

The gastrointestinal manifestations and complications of malignant lymphoma.

Malignant lymphoma involves the gastrointestinal tract as a primary or secondary in the course of disseminated lymphoma. Although primary lymphoma has received the most attention in the literature, secondary lymphoma of the gastrointestinal tract is much more common. The gastrointestinal manifestations and complications are a common problem and there is a lack of information as to diagnosis, management and prognosis. Intensive application of currently-available diagnostic techniques including radiology, cytology, endoscopy, biopsy and gastric secretory studies should be pursued for the evaluation of patients with lymphoma. The management of the multiple gastrointestinal complications such as monilial esophagitis, hemorrhagic gastritis, stress erosions, intestinal perforation, diarrhea, malabsorption and radiation damage that may then affect the gastrointestinal tract in the course of malignant lymphoma or its treatment requires very careful supportive management. Each modality of tretment for lymphoma may be associated with a variety of complications which compromise the structure and function of the gastrointestinal tract and which may be at times more devastating than the underlying neoplasm. Early recognition and active treatment of these complications is vital.

Antineoplastic Agents↗
PubMed1980

Progress report on controlled trial of fecal occult blood testing for the detection of colorectal neoplasia.

Our controlled trial of screening for colorectal cancer has now been in progress for almost five years. Screening is accomplished by rigid sigmoidoscopy in control and study groups and, in addition, by fecal occult blood testing in the study group. Patients screened are men and women age 40 and older, mostly at average risk. Fecal occult blood testing is with Hemoccult slides with patients on a meat-free, high-bulk diet without hydration, and with a four-day storage interval between slide preparation and testing. Patients with positive slides undergo diagnostic investigation that includes both colonoscopy and double-contrast barium enema and, in some, an upper gastrointestinal series. Preliminary results to date include: patient baseline statistics and subgroup comparability, rate of positive slides of 1-4%, predictive value for neoplasia of 44-50%, false-positives of 0.5-2.1%, favorable Dukes' staging of cancers in the study group, and high patient compliance. Considerably more follow-up is need in our study and control population, and issues such as mortality and cost need to be addressed. Additional time will be necessary to provide firm conclusions.

Adenoma↗
PubMed1980

The two stage provocative test for pancreatic disease by serum enzyme measurements.

The pancreas can be studied for obstructive disease by measuring serum lipase levels in the two stage provocative test. The test is nonspecific but noninvasive and applicable to all stages of pancreatic diseases. In this test, the pancreas is stimulated twice in two hour intervals before measuring the serum enzyme levels: first, with pancreozyin and secretin--the stage 1 test and, second, with pancreozymin, secretin, betazole hydrochloride and morphine sulfate--the stage 2 test. Among the pancreatic enzymes measured, lipase was most reliable. Serum lipase level elevation in the stage 1 test indicates a pancreatic abnormality and it completes the test. Patients who fail to respond to the stage 1 test have either a normal pancreas or pancreatic insufficiency and need the stage 2 test for differential diagnosis. In the stage 2 test, the serum lipase level is elevated in patients with a normal pancreas but not in those with pancreatic insufficiency. As a preliminary study, ten patients with carcinoma of the pancreas, two with pancreatitis and ten in the control group were studied. All patients with a known pancreatic disease demonstrated an abnormality in the test. Two of ten in the control group also had abnormal results. The two stage provocative test may be used prior to undertaking more invasive examinations, such as an arteriogram, in patients who are suspected of having pancreatic disease, yet other tests have failed to indicate it.

Amylases↗
PubMed1978

The value of diagnostic aids in detecting pancreas cancer.

By contract with the National Cancer Institute, the accuracy of diagnostic techniques was assessed in 184 patients suspected of having pancreas cancer. Of 138 patients who were operated upon, 89 were found to have pancreas duct cancer, 30 had cancer of a different site of origin in the head of the pancreas region and in 19 there was no evidence of cancer at operation. All of the 46 patients who were not operated upon, 13 proven to have cancer and 33 patients discharged as free of cancer, were followed in our clinic. The majority of our patients presented with signs and symptoms of biliary obstruction. Computerized transaxial tomography (CTT) gave a "correct" diagnosis in 31 of 33 patients (94%) with proven cancer, there were 2 patients with a false negative report and a false positive diagnosis occurred in 8 of 20 patients (40%) without cancer. Celiac angiography (CA) gave a correct diagnosis in 78 of 94 patients (83%) with cancer, a false negative in 17%, and a false positive in 32%. 76Selenomethionine pancreas scan correctly diagnosed 27 of 36 patients (75%) with cancer, gave a false negative in 25% and a false positive in 31%. Ultrasonography gave a correct diagnosis in 18 of 27 patients with cancer (67%), a false negative in 33% and a false positive in 28%. Endoscopic retrograde cholangiopancreatography diagnosed correctly 8 of 11 cases (73%) of cancer, there were false negative diagnoses in 3 cases (27%) and false positives in 3 of 14 patients (21%). Duodenal aspiration techniques gave a very low percentage of correct diagnoses. Chronic pancreatitis most commonly gave rise to a false positive diagnosis. Serum alkaline phosphatase was elevated in 82% of patients, gave 18% false negatives and 33% false positives. Carcinoembryonic antigen (CEA) was elevated (greater than 2.5 ng/ml) in most of the pancreas cancer patients but also in patients with other cancers and with non-cancerous diseases. In our hands, CTT, CA, alkaline phosphatase, 75Se-methionine and ultrasonography, in descending order, have given the highest percentage of correct diagnoses but false positive and false negative diagnoses prevented any single test from being conclusive.

Biopsy, Needle↗
PubMed1978

Colonoscopic biopsy and cytology in the diagnosis of colon cancer.

Colonoscopy has revolutionalized the approach to the diagnosis and management of patients with colorectal neoplasia. When malignant-appearing lesions are visualized by colonoscopy, a variety of diagnostic techniques are currently available for the assessment of the nature of the lesion including biopsy, brush cytology, and lavage cytology. Comparison of results for biopsy alone with biopsy plus either or both cytologic techniques showed a positive yield of 60% for biopsy alone; 76% for biopsy and lavage; 89% for biopsy, brush, and lavage. When the cancers were divided into infiltrative and exophytic lesions the positive yield for biopsy alone was 33% for infiltrative, cancer, and 71% for exophytic cancer; for biopsy and lavage cytology, 44% for infiltrative cancer, and 94% for exophytic cancer; for biopsy and brush cytology, 78% for infiltrative, and 94% for exophytic cancer; and for biopsy, brush, and lavage cytology, 83% for infiltrative cancer, and 92% for exophytic cancer. The use of brush cytology improved the yield of tissue diagnosis considerably when added to the biopsy technique. Lavage cytology did not seem to increase significantly the diagnostic yield. The diagnostic yield of the various techniques was related not only to the specific combination of techniques used, but also to the gross tumor pattern.

Adenocarcinoma↗