bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aggressive initial surgery for chronic radiation enteritis: long‐term results of resection vs non‐resection in 44 consecutive cases
Authors: Perrin  , Panis  , Messing  , Matuchanski  , Valleur  
Published: March 2003

ObjectiveOne third of patients with chronic radiation enteritis will require surgery. There is, however, no consensus on the best surgical strategy. The long‐term results of intestinal resection vs a `conservative' procedure, including stoma, bypass, and/or adhesiolysis, were reviewed with special reference to reoperation rates and the ultimate need for long‐term parenteral nutrition.Patients and methodsForty‐four patients operated for chronic radiation enteritis were divided into two groups: Group I resection (n = 21) and Group II conservative (n = 23). Twenty patients had received preoperative total parenteral nutrition, 16 (76%) in the resection group vs four (17%) in the conservative group (P < 0.001). In the resection group, intestinal resection was combined with a stoma in six patients. In the conservative group, 10 patients underwent adhesiolysis, five a bypass procedure, and eight diverting stoma.ResultsPost‐operative mortality was similar in both groups (9.5% vs 8.5%). Mean follow up was 53 and 55 months for Group I and Group II, respectively. The reoperation rate was significantly lower in Group I: 9 (47%) vs 19 (86%), P < 0.01. Although not significant, the ultimate need for long‐term parenteral nutrition rate was lower in Group I than in Group II: 6 (32%) vs 10 (48%).ConclusionResection resulted in better treatment outcomes than `conservative' surgery for chronic radiation enteritis.
Anal endosonography in haemorrhoidal disease: do anatomical changes have clinical implications?
Authors: Poen  , Felt‐Bersma  , Cuesta  , Meuwissen  
Published: March 2003

ObjectiveThis study was designed to evaluate anal endosonographic findings in patients with internal haemorrhoids and to test whether endosonographic parameters can serve as prognostic factors for treatment outcome and recurrence.Patients and methodsOne hundred and twenty‐nine patients (72 males, 57 females, mean age 48 years (range 19–82 years)) were treated for grade 1 to grade 3 internal haemorrhoids with either rubber band ligation (n = 62) or infrared photocoagulation (n = 67). Evaluation before and 1 month after the last treatment consisted of a symptom questionnaire, digital examination, proctoscopy and anal endosonography. The thickness of the submucosa (SMT) and internal (IST) and external anal sphincters (EST) was measured in four quadrants and averaged. Comparisons were made with 40 age‐ and sex‐matched healthy controls. Follow up was 19.2 ± 7.8 months (mean ± s.d.). Multivariate analysis was performed to identify endosonographic factors for treatment outcome and recurrence.ResultsEighty‐six patients had grade 1, 34 grade 2 and nine grade 3 haemorrhoids. At endosonography, most but not all haemorrhoids were recognized as anterior thickening of the submucosal layer with a partial hypoechoic appearance. Compared with healthy controls SMT (2.6 ± 0.8 mm vs 2.3 ± 0.5 mm, P < 0.03), IST (1.7 ± 0.5 mm vs 1.5 ± 0.5 mm, P < 0.03) and EST (8.7 ± 1.6 mm vs 7.7 ± 1.4 mm, P < 0.001) were increased. Submucosal thickness correlated with the degree of haemorrhoids (r = 0.19, P = 0.04). No difference in endosonographic appearance of anal morphology was found after treatment. With multivariate analysis no endosonographic factors could be identified which could predict treatment outcome or symptom recurrence.ConclusionHaemorrhoids are associated with endosono‐ graphic thickening of submucosal tissue, internal and external anal sphincter. Therefore, both sphincters as well as changes in the submucosa might be of pathophysiological importance. Endosonographic changes cannot predict treatment outcome or symptom recurrence.
Home rectal evacuation prior to a colorectal clinic appointment: a prospective, randomized, controlled, single‐blind trial
Authors: Lobo  , Riddick  , Iftikhar  , Gudgeon  
Published: March 2003

ObjectiveThe presence of faeces in the rectum can limit the effectiveness of diagnostic rigid sigmoidoscopy and therapeutic proctoscopy. This study was undertaken to determine whether home self‐administration of a Microlette Micro‐enema® or two glycerine suppositories improves the view on rigid sigmoidoscopy and to assess patient acceptability.Patients and methodsPatients referred with colorectal symptoms were prospectively randomized into three groups of 50. Patients in Groups I and II were sent a Microlette Micro‐enema® or two glycerine suppositories, respectively, along with instructions for home self‐administration. Group III comprised unmedicated controls.ResultsCompliance was 98%. There was no significant difference in faecal loading between Groups I and II, but both groups had significantly more patients with empty rectums in comparison with Group III (P < 0.001). The median (interquartile range) distances in cm from the anal verge reached on rigid sigmoidoscopy in Groups I, II and III were 15.0 (15.0–20.0), 18.0 (15.0–20.0) and 15.0 (4.25–15.0), respectively (Groups I vs III and Groups II vs III P < 0.001; Groups I vs II P = 0.03). Quality of views on rigid sigmoidoscopy were best in Group II (Groups I vs III and Groups II vs III P < 0.001; Groups I vs II P = 0.04). Four patients in Group I and two in Group II found home self‐administration of the enema/suppositories inconvenient or unacceptable.ConclusionHome self‐administration of two glycerine suppositories prior to a colorectal clinic visit is simple, inexpensive and acceptable to patients and allows better views on rigid sigmoidoscopy.
The clinical course of intra‐abdominal desmoid tumours in patients with familial adenomatous polyposis
Authors: Church  , McGannon  , Ozuner  
Published: March 2003

ObjectiveDesmoid tumours are benign growths of fibro‐aponeurotic tissue that are rare in the general population but pose problems in patients with familial adenomatous polyposis (FAP). Many reports of patients with desmoid tumours are unhelpful because of small numbers, inclusion of patients with and without FAP, failure to separate tumours in different sites and use of a wide variety of treatment combinations. The purpose of this study was to avoid some of these deficiencies by reviewing the clinical course of a large number of patients, all of whom have intra‐abdominal desmoids and FAP.Patients and methodsThe medical records of patients with intra‐abdominal desmoids treated at this institution were identified through the database in the David G. Jagelman FAP Registry and reviewed. Only patients who received all or part of their treatment at the Cleveland Clinic were included. Protocols for desmoid follow up call for periodic measurement of the dimensions of the tumour, either by clinical examination or on computed tomography (CT) scan. The interval between examinations ranges from 3 months to 2 years, depending on the presence of symptoms and the rate at which the tumour is growing. A change in greatest diameter of >50% is deemed significant growth or regression.ResultsSeventy patients with intra‐abdominal desmoid tumours in the setting of FAP were identified. Mean age at desmoid diagnosis was 31 years; there were 24 men and 46 women. A family history of desmoids was present in 53% of families known to have FAP. Abdominal wall tumours were also present in 18 patients. Most desmoids presented after surgery (53/70) and multiple tumours were found in 24 patients. The commonest presentation of desmoid tumours was as an abdominal mass. One third of patients had no symptoms at presentation. Treatment included surgery (32), medicine (41) chemotherapy (10) and radiation (4). Eleven patients received no treatment. At the time of review 12 patients were dead (11 from desmoids), 15 were symptomatic and 41 asymptomatic. In seven cases the desmoid disappeared, two spontaneously, two after excision, and three after chemotherapy. Thirty‐four patients were being treated at the time of review, 29 with sulindac.ConclusionThe outcome in these cases shows that most intra‐abdominal desmoid tumours in FAP are indolent mass lesions that may vary a little in size and do not cause serious harm to the patient. Medical treatments are usually ineffective; surgery is at best unwise and at worst the cause of disastrous complications. A small proportion of desmoids grow rapidly and usually lead to the patient's death. For these patients, anti‐sarcoma type chemotherapy is the only hope.
Is colon cancer management in a comprehensive cancer centre evidence‐based?
Authors: Ray‐Coquard  , Philip  , Négrier  , Desseigne  , Rivoire  , Fervers  , Farsi  , Chauvin  
Published: March 2003

Objectives Between 1993 and 1994, the 80 physicians in the French comprehensive cancer centre, Léon Bérard, developed and implemented Clinical Practice Guidelines (CPGs) based on an analysis of the literature and a␣consensus of intra‐institutional experts. This study reports the impact of CPGs on the management of colon cancer and the identification of patients’ characteristics linked with CPGs’ compliance rates.Patients and methods A ‘before‐after’ study, using records of colon cancer patients, was performed. Records for all patients newly referred with colon cancer in 1993 and 1995 (n = 77 and n = 81, respectively) were selected in 1993 and 1995. Medical decisions on these records were analysed to assess their compliance with the CPGs. Univariate and multivariate analyses of compliance factors for the CPGs were performed on the cohort of 128 patients. A systematic search of the literature was performed to determine the scientific evidence for non‐compliant decisions.Results The compliance rate for colon cancer was significantly higher in 1995 than in 1993, 70% (62/88) (95% confidence interval (CI), 60–80%) vs 50% (34/68) (95% CI, 38–62%) (P = 0.009). Using logistic regression, year of management 1995 (OR 2.8; 95% CI, 1.12–6.9), metastatic stage (OR 4.12; 95% CI, 1.43–11.8), and Karnofsky scale > 70 (OR 11.5; 95% CI, 1.14–41.4) were identified as independent factors for compliance with the CPGs. In 1993 and 1995, 71% (48/68) (95% CI, 60–81%) and 81% (71/88) (95% CI, 73–89%), respectively, of medical decisions for colon cancer, conformed to the CPGs or were judged to be based on ‘scientific evidence’.Conclusion Compliance rates were significantly higher in 1995. The development and implementation of CPGs for cancer management seemed to result in significant changes in medical practice. Moreover, the patients’ characteristics appeared to influence compliance with the guidelines.
A novel method to avoid pelvic adhesions following Hartmann’s procedure
Authors: Velitchkov  , Vassilev  , Belokonsky  , Losanoff  , Kjossev  
Published: March 2003

Objective To report the preliminary results of a novel method to avoid adhesions in the pelvis following Hartmann’s procedure.Patients and methods Nine patients (seven males, 88%) aged 20–63 years underwent Hartmann’s procedure between 1994 and 1997. On completing the procedure a round sheet of polyethylene foil was placed on the pelvic floor aimed at avoiding the formation of adhesions between the rectal stump and small bowel.Results Laparoscopically assisted reversal was performed 1 month later in five (58%) patients, and between 1.5 and 2 months later in the remaining four. No adhesions between the small bowel and other viscera, to the foil, and rectal stump were found. The completion of the colorectal anastomosis met no difficulty and there was no morbidity.Conclusion This method may offer significant surgical benefit, but more work is required to evaluate the technique further.
An analysis of site‐specific attributable pathologies for colorectal symptoms: diagnostic yield of colonoscopy
Authors: Zbar  , Pignatelli  , Sherman  , Toomey  , Kmiot  
Published: March 2003

Objective The aim of this prospective study was to audit the diagnostic yield of colonoscopy for an unselected cohort of patients referred with lower intestinal symptoms.Patients and methods Seven hundred and forty‐four consecutive patients over a 12‐month period were analysed. The main reasons for referral included rectal bleeding, iron deficiency anaemia, altered bowel habit, abdominal pain, colonoscopic follow up (for colitis, prior endoscopic polypectomy and after colorectal cancer resection) and screening (positive family history of colorectal cancer).Results Rectal bleeding had a diagnostic yield of 69.4% (neoplastic yield of 23.8%). Over 50% of patients with anaemia had normal colonoscopies (23.7% yield for colorectal neoplasia). Only one carcinoma was found in 133 patients colonoscoped for abdominal pain or altered bowel habit (0.75%). New carcinoma diagnoses were made in 1.6% (1/59) of patients followed up after cancer resection and in 1.5% of those patients with prior endoscopic polypectomy (1/65).Conclusion Colonoscopy is valuable as a routine investigation in patients presenting with rectal bleeding or iron deficiency anaemia.
Full thickness transrectal advancement flap for high anal fistula
Authors: Rieger  , Stitz  , Lumley  
Published: March 2003

ObjectiveTo determine the results of full thickness transrectal advancement flap for the treatment of high anal fistula.Patients and methodsA retrospective case study analysis.ResultsA primary healing rate of 71% was achieved and overall with further operative procedures, 97% healed. Only one patient, who had Crohn’s disease, has not healed and has a stoma. Four patients had a successful second full thickness flap repair after primary failure. The result for patients with intestinal Crohn’s disease was less satisfactory, with a recurrence rate of 50% in six patients. Disturbed continence was seen in four (12%) patients.ConclusionThe results of full thickness transrectal advancement flap were satisfactory in the treatment of high anal fistulae. The overall rate of healing was high and there was a low incidence of disturbed continence.
p27kipl protein expression: an independent prognostic factor in rectal carcinoma stages I–III
Authors: Pucciarelli  , Esposito  , Fassina  , Alaggio  , Masin  , Toppan  , Chieco‐Bianchi  , Lise  
Published: March 2003

ObjectiveTo evaluate the impact of some molecular markers on lymph node metastases, overall (OS) and disease‐free survival (DFS) in rectal cancer.Patients and methodsWe investigated p27kip1, p53, nm23, and vascular endothelial growth factor (VEGF) expression in 109 primary rectal cancer specimens (stage I, n=38; stage II, n=24; stage III, n=20; and stage IV, n=27) from patients operated on between 1990 and 1995 at Clinica Chirurgica II.ResultsTumour differentiation (P=0.0469), depth of rectal wall invasion (T status) (P=0.0000), distant metastases (P=0.0000), vascular invasion (P=0.0000), and p27kip1 expression (P=0.0022) were associated with lymph node metastases (N status). During follow up (median duration 47 months), 48 patients died, and 25 patients (stages I–III) had recurrences. At multivariate analysis, T and N status, and intratumoural necrosis were independent risk factors for OS. The relative risk (RR) of death for patients with lymph node metastases, advanced T status and intratumoural necrosis was 3.3 (P=0.0002), 2.03 (P=0.0127), and 1.47 (P=0.1935), respectively. When analysis included only stage I–III patients, N status and p27kip1 protein expression were found to be independent risk factors for OS. The RR of death for patients with lymph node metastases and those without p27kip1 expression was 2.98 (P=0.0251), and 3.57 (P=0.0231), respectively. At multivariate analysis, N status, p27kip1 expression, and intratumoural necrosis were independent risk factors for DFS. The RR of recurrence for patients with lymph node metastases, intratumoural necrosis and absence of p27kip1 expression was 6.29 (P=0.0001), 3.04 (P=0.0168), and 3.25 (P=0.0387), respectively.ConclusionAbsence of p27kip1 expression is a useful marker of tumour aggressiveness in rectal carcinoma stages I–III, and an independent predictor for OS and DFS.
Manual dilatation of the anus—still widely practised in the West of Scotland
Authors: Coull  , McCourtney  , Finlay  , Dalling  
Published: March 2003

ObjectiveTwo main surgical options exist for the current treatment of chronic anal fissure: manual dilatation of the anus (MDA) and lateral internal sphincterotomy (LIS). The high incidence of incontinence after MDA is widely documented. One study carried out in the West of Scotland in 1992 showed that 49% of patients undergoing MDA subsequently suffered some degree of incontinence. This study was set up to determine the number of surgeons in the region who continue to use MDA in their clinical management of chronic anal fissure.MethodsAll consultant and higher surgical trainees in General Surgery in the West of Scotland were circulated with a postal questionnaire in November 1996 requesting how long they had been in post and to state their current preferred treatment of choice for chronic anal fissure.ResultsAlmost half the consultant surgeons (47%) in the West of Scotland favour MDA as their treatment of choice and its utilization increases according to seniority. In contrast, registrars and junior consultants predominantly use LIS.ConclusionThese data show a high incidence of MDA as the treatment of choice for chronic anal fissure amongst consultant surgeons in the West of Scotland. The implications of such a practice are discussed.
Transanal endoscopic microsurgery (TEM): a tool for minimizing the extent of surgery in synchronous colorectal tumours
Authors: Lev‐Chelouche  , Margel  , Ravid  , Goldman  , Rabau  
Published: March 2003

ObjectiveSynchronous colorectal neoplasms are a common pathology which at times necessitate extensive abdominal surgery. When one of the lesions is located in the rectum, the operation harbours even higher rates of morbidity and mortality. In such cases, we suggest a two‐step procedure, comprising TEM resection for the rectal tumour followed by a less extensive abdominal resection for the second.Patients and methodsDuring 1998, six patients (mean age 74 years) with two synchronous colorectal neoplasms were operated using TEM resection for the rectal lesion (villous adenoma (n=3), adenocarcinoma (n=3)), followed 2–4 weeks later by abdominal surgery (Rt. colectomy (n=2), Lt. colectomy (n=4)) for the synchronous lesions, all of which were adenocarcinomas.ResultsThere was no mortality and only minor reversible complications after both operations. Mean post‐operative stay after TEM excision was 3 days and rehabilitation was satisfactory enabling performance of the second operation after 2–4 weeks. All rectal tumours were resected with clear margins. Two were at stage T1 and one T2. Median follow up is 8 months with no evidence of recurrent neoplasm in any patient.ConclusionTEM excision of a rectal neoplasm, combined with transabdominal resection of a synchronous colonic tumour, allows the extent of surgery to be minimized, resulting in lower morbidity and mortality rates.
Magnetic resonance imaging of perianal fistulas: predictive value for Parks classification and identification of the internal opening
Authors: Holzer B. , Rosen H. R. , Urban M. , Anzböck W. , Schiessel R. , Hruby W. 
Published: March 2003

ObjectiveMRI has been reported to be valuable in the investigation of patients with fistula in ano. The aim of this study was to evaluate the results of preoperative magnetic resonance imaging (MRI) in such patients using a surface coil and to compare it with surgical findings.Patients and methodsIn a prospective study, 28 patients (19 males, nine females, median age 39 years) with perianal fistula underwent preoperative MRI. Parks classification as well as the identification of an internal opening into the anal canal and/or rectum were compared with the surgical findings.ResultsClassification during surgery revealed five extrasphincteric, eight transsphincteric, seven suprasphincteric and eight intersphincteric fistulas. All patients with intersphincteric, suprasphincteric and transsphincteric fistulas were correctly classified by MRI. The comparison of MRI and surgical results revealed a concordance in 27 of 28 (96%) patients in terms of classification (κ 0.95, P < 0.01) and in 21 (75%) patients regarding the identification of the internal opening (sensitivity 63%, specificity 92%).ConclusionOur results indicate that MRI of perianal fistulas with the use of extra‐anal surface coils can accurately assess the surgical anatomy. It is a rapid, well‐tolerated technique which might play an important role in the management of perianal fistula.
Peri‐operative management of patients having external anal sphincter repairs: temporary prevention of defaecation does not improve outcomes
Authors: Ingham Clark C. L. , Wilkinson K. H. , Rihani H. R. , McDonald P. J. , Northover J. M. , Phillips R. K. S. 
Published: March 2003

ObjectiveTo determine whether there was any detectable difference in outcomes of external anal sphincter repair depending on whether patients were managed routinely with a covering stoma, a constipating dietary regimen or a laxative dietary regimen in the early postoperative period.Patients and methodsA consecutive retrospective series of 299 anal sphincter repairs undertaken on 286 patients within a single institution was studied. Patients were divided into three groups depending on the peri‐operative regimen followed: routine use of a covering stoma (group 1), routine use of a postoperative constipating dietary regimen (group 2) and routine use of a laxative dietary regimen (group 3). Choice of peri‐operative regimen depended on surgeon preference alone. Short‐term outcomes (length of stay, complications) and long‐term outcomes (functional reported degree of continence, anal ultrasound and physiology test results) were assessed in relation to peri‐operative group as well as aetiology of sphincter damage.ResultsShort‐term results (complications of surgery) were obtainable in all patients; long‐term results were available for 89% of patients. Length of stay was similar for all 3 groups (excluding re‐admission for stoma closure). Complication rates were not significantly different between the three groups. Functional improvement in continence was reported by 68% of group 1, 69% of group 2 and 79% of group 3 (differences not statistically significant). An anatomical sphincter defect was detected postoperatively in 8% of patients in group 1, 9% in group 2 and 7% of group 3. Poorer outcomes were achieved in older patients and in patients with previous ileo‐anal pouch formation. Early faecal impaction and repair breakdown were independently associated with poor long‐term outcomes.ConclusionsNeither routine use of a covering stoma nor a postoperative constipating regimen produced better results following external anal sphincter repair than did the use of a postoperative laxative regimen which encouraged early passage of loose stool without the need for straining.
The dose response of the internal anal sphincter to topical application of glyceryl trinitrate ointment*
Authors: Cundall J. D. , Gunn J. , Easterbrook J. R. , Tilsed J. V. T. , Duthie G. S. 
Published: March 2003

IntroductionGlyceryl trinitrate (GTN) ointment has been used for the treatment of chronic anal fissure based on the assumed pathophysiology that the fissure is due to internal anal sphincter hypertonia and that GTN causes relaxation.Method48 patients, with a diagnosis of haemorrhoids, underwent 24 h anal manometry following application of different concentrations (placebo, 0.1%, 0.2%, 0.4%) of GTN ointment.ResultsWe have found that there was a progressive relaxation with increasing doses (placebo −8.8%, 0.1% GTN −21.9%, 0.2% GTN −27.2%, 0.4% GTN −33.1%). One way ANOVA showed this progression was significant (P=0.020), with the difference lying between placebo and 0.4% GTN (Tukey multiple comparisons, P=0.017). Only 3 patients experienced headaches and these were split evenly between the treatment arms.ConclusionThe internal anal sphincter has a dose related response to GTN and when dose application is strictly applied higher doses may be used without an increase in side‐effects.