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Tom Balfour

Bio: Tom Balfour is an academic researcher from Queen's University. The author has contributed to research in topics: Sigmoid colon & Colonoscopy. The author has an hindex of 2, co-authored 3 publications receiving 2788 citations.

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Journal ArticleDOI
TL;DR: Evidence from this study and other trials suggest that consideration should be given to a national programme of FOB screening to reduce CRC mortality in the general population.

2,778 citations

Journal ArticleDOI
TL;DR: The acceptance-rate was low (25%) in those over the age of seventy-five and was highest in those aged fifty-five to sixty, and 3.8% of those using the test had at least one positive haemoccult test.

78 citations

Journal ArticleDOI
Tom Balfour1
TL;DR: Early Diagnosis of the Acute Abdomen, worshipped by three generations of surgeons, is now in its 21st edition; Zachary Cope's versions are now in the rare-books section of medical libraries.
Abstract: Old men dream dreams of elegant clinical diagnoses; young men see visions of perfect cross-sectional images. Early Diagnosis of the Acute Abdomen, worshipped by three generations of surgeons, is now in its 21st edition; Zachary Cope's versions (from 1921) are now in the rare-books section of medical libraries; the last seven (from 1980) have been revised by Professor William Silen of Harvard Medical School. He has made a noble attempt to retain the original emphasis on diligent clinical assessment, whilst guiding the reader towards appropriate laboratory and radiological investigations. Sadly the reproduction of the CT (computerized tomography) images is so poor as almost to defeat this objective. Much of the original elegant text (with simple line diagrams) has been retained, and in this age of evidence-based medicine one might question some of Cope's maxims. ‘Severe abdominal pain that lasts more than six hours is caused by some condition of surgical import’. Often but not always! The ‘sweating brow’ may not be caused by a perforated ulcer; the ‘dull gaze and ashen countenance in severe toxaemia’ will not be adequately confirmed by ‘the back of the hand placed on the patient's nose and cheek’. But I exaggerate. Professor Silen has attempted to identify appropriate complementary tests rather than suggest every conceivable investigation; for example, there is evidence that CT is over-used in patients with an ‘acute abdomen’. The saving grace is that this same technique has led to a greater appreciation of applied surgical anatomy, which was always emphasized by Sir Zachary. Yet his standard of clinical evaluation would exceed most of our abilities. How many would ‘personally examine the blood smear and urinary sediment’? To exclude tabes dorsalis would our junior surgeons test the knee jerks and examine the pupils? Mr Cope, as he then was, would have been perplexed by the added sections on laparoscopy or immunocompromised patients, for example, but he would doubtless rejoice that degrees Fahrenheit had not been banished by Celsius. There is much repetition in the text as individual acute abdominal problems are discussed, each with its recurring differential diagnosis; but who could resist the inclusion of Sir Zachary's personal account of his own acute cholecystitis in 1969, at the age of 80—‘one is never too old to learn’, he concluded. No biography is offered in this new edition, nor is it necessary; the original text remains its own definitive reference. This is a brave attempt to continue the resuscitation of a unique book. It will be of interest to those with a love of books and of the history of 20th century surgery. It will appeal less to trainee surgeons seeking a core text to prepare for 21st century examinations; they must look elsewhere. Every surgeon should heed Cope's note of caution when dealing with an acute abdomen: ‘the dextrous hand must not be allowed to reach before imperfect judgment’.

1 citations


Cited by
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Journal ArticleDOI
TL;DR: Clinicians should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and those that can detect cancer early and also can detect adenomatous polyps.

2,876 citations

Journal ArticleDOI
TL;DR: Evidence from this study and other trials suggest that consideration should be given to a national programme of FOB screening to reduce CRC mortality in the general population.

2,778 citations

Journal ArticleDOI
TL;DR: Findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer.
Abstract: BACKGROUND In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group). RESULTS Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

2,381 citations

Journal ArticleDOI
TL;DR: These guidelines differ from those published in 1997 in several ways: the screening interval for double contrast barium enema has been shortened to 5 years, and colonoscopy is the preferred test for the diagnostic investigation of patients with findings on screening and for screening patients with a family history of hereditary nonpolyposis colorectal cancer.

2,196 citations

Journal ArticleDOI
TL;DR: This guideline report presents the panel’s recommendations with respect to screening and surveillance in people at average risk for CRC and those at increased risk because of a family history of CRC or genetic syndromes or a personal history of adenomatous polyps, inflammatory bowel disease, or curative-intent resection of CRC.

1,862 citations